Retinal hole
A retinal hole is a small, round opening in the thin layer of tissue lining the back of the eye. This tissue (the retina) detects light and helps produce vision. A hole in the eye of this kind is usually located in the peripheral retina (away from the centre of sight) and are often found during routine eye examinations or when assessing floaters or flashes.
Many retinal holes cause no disturbance to vision and can be safely observed. Others carry a higher risk of developing into a retinal detachment, and in those cases, treatment is recommended to prevent that from happening.
How do retinal holes occur?
A retinal hole occurs when a small, round gap forms in the delicate tissue lining the back of the eye. It often develops as part of the natural ageing process, when the vitreous, the clear gel inside the eye, becomes more liquid and pulls on the retina. If the retina is thin or fragile in certain areas, this traction can create a hole.
Causes of retinal holes
Other factors can increase the likelihood of a hole in the eye forming:
- High myopia (short-sightedness): The eye is longer and the retina more stretched, making it thinner and more prone to breaks.
- Previous eye surgery: Procedures such as cataract removal can increase risk.
- Eye injury: A direct blow to the eye can create a hole, particularly in younger adults.
- Naturally thin retina: Some people are born with areas of thinner retinal tissue, which are more vulnerable.
- Not caused by daily activity: Everyday tasks or normal visual use do not create retinal holes - they result from structural changes or injury.
Symptoms to be aware of
Most retinal holes are symptom-free. When symptoms are present, they can include:
- New or increased floaters (dark spots, threads, or cobweb-like shapes)
- Brief flashes of light in peripheral vision
- A small patch of blurred or shaded vision
If the hole progresses and fluid begins to pass underneath the retina, symptoms will become more pronounced:
- A curtain or veil moving across your vision
- Sudden loss of side vision
- A rapid increase in floaters or flashes
Any sudden change in symptoms should be reported immediately, as it may indicate the start of a retinal detachment.
Diagnosis
Diagnosis is made during a dilated retinal examination, allowing the specialist to see the far edges of the retina. If the hole is near the centre of vision, an optical coherence tomography (OCT) scan may be performed to produce a cross-section image of the retina.
The examination will determine:
- The size and position of the hole
- Whether there is any fluid under the retina
- If there is traction pulling at its edges
- Other risk factors, such as short-sightedness or a history of retinal problems
Monitoring and prognosis
With careful monitoring, most retinal holes remain stable and never cause vision loss. The aim is to detect any early signs of change so that treatment can be carried out before detachment occurs.
When treatment is needed, laser retinopexy is one of the most effective approaches. This seals the retina around the hole to reduce the risk of fluid passing underneath. For low-risk holes, observation with regular follow-up appointments is usually the safest option.
The outlook for a retinal hole is generally very good when appropriate management is in place.
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