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# Macular hole

A small full-thickness hole in the centre of the [retina](https://durgical.com/en/anatomy/retina/) causes a central blind spot and distortion. Surgery closes most holes.

Updated Nov 5, 2026

## Quick facts

**Key signs**
Central blurred vision in one eye · Difficulty reading

**Diagnosis**
OCT

Red flags ↓ No doses: the clinician sets them by the current guideline.

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Pathophysiology
- Classification
- In ophthalmology

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Goal of treatment
- Treatment

- Study Test yourself

- Connections Connections

## What it is

A full-thickness defect in the neural retina at the fovea. Most are idiopathic, caused by traction of the [vitreous](https://durgical.com/en/anatomy/vitreous-body/) on the fovea as it detaches, typically in older women. It causes central blur, distortion and a central blind spot in one eye. Vitrectomy surgery closes most holes and improves vision.

See it in 3D

- [Macula](https://durgical.com/en/anatomy/macula/)
- [Retina](https://durgical.com/en/anatomy/retina/)
- [Vitreous](https://durgical.com/en/anatomy/vitreous-body/)

## Who gets it

Most common in women in their sixties and seventies; usually one eye, with a small risk in the other.

## Causes

- Vitreous traction during posterior vitreous detachment (idiopathic)
- Trauma
- High myopia
- Chronic macular oedema

## Risk factors

- Female sex
- Age over 60
- High myopia
- Eye trauma

## Pathophysiology

As the vitreous separates, it pulls forward on the fovea, which splits and opens. The edges of the hole lift and the photoreceptors at the centre are lost, creating a central scotoma.

## Classification

- By stage, from impending hole to full-thickness hole with complete vitreous detachment
- By size of the hole on OCT

## Symptoms and signs

- Central blurred vision in one eye
- Distortion of straight lines (metamorphopsia)
- A central dark or missing spot
- Difficulty reading

## Red flags

- New distortion or central blur: rule out neovascular macular degeneration
- Shadow in the peripheral field (detachment)

## Diagnosis

**Clinical**
Slit lamp fundus examination shows a round red defect at the fovea; the Amsler grid shows distortion or a missing centre.

**Tests**
No laboratory tests.

**Imaging**
OCT confirms the diagnosis, measures the hole and stages it.

## Differential diagnosis

- Lamellar macular hole
- Epiretinal membrane with pseudohole
- Neovascular macular degeneration
- Central serous chorioretinopathy

## Goal of treatment

Close the hole to restore central vision.

## Treatment

**Surgical**
Vitrectomy with peeling of the internal limiting membrane and a gas bubble, with head positioning for some days after surgery.

**Follow-up**
Observation for impending holes, some of which close spontaneously.

## Complications

- Permanent central scotoma if untreated
- After surgery: cataract, retinal detachment, raised eye pressure

## Prognosis

Surgery closes most holes; earlier surgery on smaller holes gives better vision.

## Test yourself

Think of the answer, then tap the question to see it.

## What causes most macular holes?

Traction of the vitreous on the fovea as it detaches (idiopathic).

## Which test confirms a macular hole?

Optical coherence tomography (OCT).

## How is a full-thickness macular hole treated?

Vitrectomy with internal limiting membrane peeling and a gas bubble.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/conditions/macular-hole/)

## In ophthalmology

- [Retinal detachment surgery: buckle, vitrectomy, gas and posturing](https://durgical.com/en/ophthalmology/retinal-detachment-surgery-buckle-vitrectomy-gas-and-posturing/)

## Connections

## Related conditions 2

- [Age-related macular degeneration](https://durgical.com/en/conditions/age-related-macular-degeneration/)
- [Retinal detachment](https://durgical.com/en/conditions/retinal-detachment/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Macular Hole](https://www.ncbi.nlm.nih.gov/books/NBK559200/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/macular-hole/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/macular-hole/