The causeway carries Pine Island Road (CR 78) and consists of three bridges with dredged land sections in between them.

The islands connected to the middle of the causeway are also home to the community of Matlacha (pronounced mat-la-SHAY).

[2] Before the causeway was built, Stringfellow would have to travel from his home in Pineland via a mule-drawn wagon south to St. James City to catch a steamboat to Fort Myers for county commission meetings.

[13][14] On September 28, 2022, the Pine Island Causeway was heavily damaged by the landfall of Hurricane Ian.

The hurricane washed out the approaches to the bridges making them impassible, which greatly hindered rescue and recovery efforts on Pine Island.

[16] The Florida Department of Transportation is working with Lee County on permanent repairs to the Pine Island Causeway.