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Macular Hole

What is A Macular Hole?

The eye functions much like a camera. It has a lens system in the front of the eye to focus light onto the “film” in the back of the eye, the retina. The light passes from the surface of the eye to the retina by passing through the clear vitreous gel which fills the inside of the eye.

As we age, the vitreous jelly in our eye turns to liquid. The vitreous pulls away from the retina as it liquefies. In a small percentage of people, as the vitreous separates, it exerts traction on the macula – the center of the retina that is responsible for our sharp, central vision functions like reading small print, threading a needle, or identifying small objects with fine detail. This tugging can ultimately lead to a hole forming in the center of the macula – a macular hole.

While most often caused by age, macular holes can also occur as a result of eye disease or injury.


Macular holes often begin gradually. Symptoms can include:

  • A slight distortion or blurriness in straight-ahead vision
  • Straight lines or objects can begin to look bent or wavy.
  • Difficulty reading or performing other routine tasks

Risk Factors

  • Age
  • Female — occurs more often in women
  • Diabetes
  • History of a retinal tear or detachment
  • Inflammation in the eye (uveitis)
  • Retinal vein occlusions


Your ophthalmologist will perform a comprehensive dilated eye exam as well as a test called optical coherence tomography (OCT). This special camera takes very detailed photos of your retina and macula.


Macular holes are most often treated through a surgery called vitrectomy which involves removing the vitreous gel that is pulling on the retina and filling the vitreous cavity with a gas bubble. This bubble pushes against the macular hole, helping it to flatten and close. This allows the tissue to heal and return to a normal position, improving vision over time. Over a period of two to eight weeks, the gas bubble is slowly reabsorbed into the bloodstream.

Macular hole surgery is done as an outpatient procedure and usually can be performed in one hour or less. A few important things to know about vitrectomy surgery:

 After surgery, patients are asked to keep their face down or in a certain position for up to a week and sometimes longer. This helps to keep the gas bubble in place so that the eye heals properly. To assist patients with the face-down positioning, there are positioning aids that may be rented from specialty companies. Your Texas Retina physician can provide you with additional information.

 Patients cannot fly in an airplane until the gas bubble is completely gone. This is because altitude can cause eye pressure to rise, leading to problems with the bubble and healing.

 If you require any other type of surgery, be sure to tell your physician that you have a gas bubble in your eye.

 It may take several months for the hole to heal.

The most common side effect of macular hole repair is cataract formation that often requires surgery within six months of the macular hole repair.