What Is a Macular Hole?

Editor: Dr. Russel Lazarus, Published February 3, 2021

Macular holes affect up to 4 in 1,000 people above the age of 55. 

A macular hole is a small tear in the center of the macula, the part of the retina responsible for central vision and vision of fine details.

A macular hole can significantly impact your vision— preventing you from enjoying your daily activities and affecting your quality of life.

Fortunately, with early detection and treatment your clear vision can be restored.

How does a macular hole occur?

A macular hole most often occurs when the vitreous humor, the gel that fills the inside of the eyeball, shrinks and pulls away from the retina— usually as a result of aging.

In most cases, the vitreous can pull away from the retina without any complications. However, if the vitreous sticks to the retina, it will pull on the retina, causing the macula to stretch, and lead to a tear or hole in the macula.

In some cases, a macular hole can develop from macular swelling that occurs as a result of another eye disease, an eye injury or trauma to the retina.

Several conditions can increase your risk of a macular hole, including:

Symptoms of a macular hole

A macular hole can cause blurry, wavy, or distorted central vision. 

These symptoms may be difficult to notice at first, but as the condition worsens and the hole grows bigger, a dark blind spot will form in the central visual field, blocking central vision.

How are macular holes treated?

Some macular holes may seal by themselves, but in most cases, a surgical procedure, called a vitrectomy is performed to treat the condition and improve vision.

A vitrectomy is performed under local anesthesia. The procedure involves the removal of the vitreous gel that fills the inside of the eye. This gel is attached to the retina, and pulls on the retina as it shrinks.

The vitrectomy (removal of the gel) helps to relieve any traction caused by the gel pulling away from the retinal surface. Once the gel is removed, the eye is filled with a gas bubble that helps to flatten the edges of the macular hole and hold it in place as it heals.

What to expect following a vitrectomy

Following a vitrectomy, your eye doctor will instruct you to remain in a face-down position for a day or two— though in some cases when the surgical repair is more extensive, for up to two to three weeks. The face-down position is crucial for recovery, as it enables the gas bubble to efficiently press against the macula. As the hole heals, the bubble will disappear and the natural eye fluid will return.

Your eye doctor can recommend specialized equipment to facilitate face-down positioning to make your recovery period more comfortable.

Early detection of a macular hole can reduce your risk of permanent damage and vision loss. 

If you are experiencing any changes to your vision, schedule an appointment with your eye doctor for a comprehensive exam of your eye health and vision.