Retinal Holes: Signs, Symptoms & Treatment

A retinal hole is a serious condition that can lead to permanent visual impairment. It is a small tear in a small area in the back of the eye known as the macula.

Because the macula is involved in centralized and focused vision, it is necessary for fine motor tasks and anything that requires focused attention within the center of the visual field. Damage to the macula can result in blurred or distorted vision. 

Signs and symptoms are divided into early and late stages, with the prognosis depending on how early they are detected. Most cases involve surgical repair. 

What Is a Retinal Hole?

A retinal hole is a tear in the eye’s posterior segment. This area of the eye is made up of light-sensitive tissue that enables vision to occur. When light enters the retina, it is transformed into an electrical signal that allows for visual perception to occur in the visual cortex. 

Since the macula is responsible for controlling central and color vision, a retinal (or macular) hole can disrupt the ability to distinguish colors or to see clearly in fine detail.

Retinal holes are rare, with an incidence of approximately 8 cases per 100,000 people. The most significant predictors of retinal holes are age and biological sex. The majority of cases involve women over the age of 60. 

Looking for the Best LASIK Near You?

Find a LASIK Surgeon

Danger of a Retinal Hole

The level of danger involved with a retinal hole depends on the progression of the condition. In advanced stages of a retinal hole, retinal detachment can occur, and this constitutes a medical emergency that warrants immediate attention. 

Retinal detachment is a condition in which the underlying tissue becomes separated from the retina, and this can lead to permanent partial or complete loss of vision. However, even if retinal detachment has not occurred, a retinal hole is a serious medical condition that requires an urgent consultation with an eye doctor. 

Symptoms

Symptoms of a retinal hole are divided into early and late stages.

• Early stage symptoms: The most common symptoms of a retinal hole in its early stages will be wavy vision and blurred vision. 
• Late stage symptoms: As a retinal hole progresses in severity, you will likely lose central vision and the ability to focus in fine detail. 

Diagnosis

A diagnosis is made by an eye doctor using a dilated eye examination as well as optical coherence tomography. The latter is a non-invasive imaging test involving the use of light waves that allows an eye doctor to examine the retina in detail. 

Types of Retinal Holes

Retinal holes vary based on their causes and characteristics. The following are types of retinal holes that have been identified:

• Atrophic retinal hole: This is a type of retinal hole that is not due to vitreous traction, but it can display abnormal vitreous adhesion. These types of retinal holes are contained with, or adjacent to, lattice degeneration and can be of full or partial thickness. Atrophic retinal holes often do not produce noticeable symptoms.
  
• Operculated retinal holes: These are retinal holes that originate in focal areas where vitreoretinal abnormalities are present. These holes are caused by any condition or pathology in which strong vitreous adhesion occurs. 

• Horseshoe or flap tears: These are thick breaks of the neurosensory retina, occurring due to vitreous traction. These types of retinal holes are usually caused by posterior vitreous detachment. Risk factors for these types of retinal holes include being older, having pre-extant degeneration of the lattice, myopia, and eye trauma.
  
• Retinal dialysis and giant retinal breaks: These are full thickness tears that extend at least three clock hours in a visual representation of the eye as the face of a clock. Retinal dialysis is a specific type in which the ora serrata is adjacent to the anterior portion of the retina.  

Causes

A retinal hole is primarily associated with aging. It is essentially an example of a defect that occurs as the eye declines in functionality over time. 

With age, fibers in the fluid that fills the eye and provides it with its shape, known as the vitreous, progressively shrink in size. In cases in which these fibers are too firmly connected to the retina, they can cause tearing as they retract, and a retinal hole develops. 

Some conditions are linked with retinal holes as well, including these:

• Myopia, or nearsightedness  
• Cataracts
• Trauma to the eye
• Eye surgery 
• Diabetes mellitus

Retinal Hole Laser Treatment

Retinal holes can be treated if they are noticed early enough, often with laser treatment. This involves the use of focused light to repair a small area of tissue without damaging surrounding tissues. 

How It Works

Your doctor will shine a medical laser inside your eye, causing small burns around the hole or tear in the retina. These burns then induce the body’s natural immune response and scarring occurs. These scars eventually heal, fixing the tear and helping to hold the retina in place. 

What It Does

The scars that form caused by laser treatment heal, creating healthy new tissue that seals the hole. The result is essentially patching the hole and the presence of new tissue to hold the retina together. 

Side Effects

Laser treatment is highly effective for treating retinal holes. However, you will likely experience some side effects as your body recovers. Some of these effects may include the following:

• Redness
• Inflammation
• Itchiness
• Pain
• Infection
• Scarring
• Changes in the color of the skin surrounding the eyes
• Acne related to the application of creams and bandages following treatment

Medical Supervision

Since it’s important to treat retinal holes as early as possible, see an eye doctor if you notice any changes in your eyes or vision. Even if your symptoms are mild, such as very slightly wavy vision, see a doctor promptly. They may recommend monitoring the condition initially, but you should be under medical supervision for this process.

References

1. A Field Guide to Retinal Holes and Tears. (June 2019). Review of Optometry.

2. Macular Hole. (May 2022). National Eye Institute.

3. Incidence of and Risk Factors for Developing Idiopathic Macular Hole Among a Diverse Group of Patients Throughout the United States. (April 2017). JAMA Ophthalmology.

4. The Safety and Effectiveness of 0.16 mg Bevacizumab Plus or Minus Additional Laser Photocoagulation in the Treatment of Retinopathy of Prematurity. (June 2019). Indian Journal of Ophthalmology.

5. What Is Optical Coherence Tomography? (March 2022). American Academy of Ophthalmology.