A macular hole is when an opening forms in the middle of the light-sensitive tissue at the back of the eye. It can lead to people having a blurry or black spot in the center of their vision.

The symptoms of a macular hole may worsen over time without treatment, although total loss of sight does not occur.

Doctors typically treat macular holes with surgery to repair the damaged tissue, with good success rates.

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When a macular hole first develops, the symptoms may not be obvious. Macular holes typically form in one eye rather than both, meaning the unaffected eye can compensate.

In the early stages, people may experience some loss or distortion in the center of their vision. Objects and straight lines may appear blurred or wavy.

Over time and without treatment, this affected area may become more blurry or distorted until a person cannot see anything in this central point.

A person with a macular hole in one of their eyes might experience the following:

  • straight lines appearing wavy
  • difficulty with tasks such as reading, writing, and driving
  • not being able to see some letters or words when reading
  • not being able to see a person’s nose or eyes when looking at their face

Macular holes do not affect peripheral vision, which is a person’s side vision. They also do not cause physical pain or discomfort.

Learn more about the stages of a macular hole.

It is unclear what causes most macular holes. A hole can develop when the macula, which is the central area of the back of the eye, becomes stretched or something pulls at it.

One condition that can affect the macula in this way is called vitreomacular traction, or vitreous traction. In this condition, the gel that fills the center of the eye begins to pull away from the tissue at the back of the eye. This pulling apart is called vitreous detachment.

Macular holes can occur at any age, although they are most common in females in their 50s and 60s. General risk factors for the condition include:

  • being 60 years old or older
  • having had a macular hole in one eye already
  • having had an eye injury or eye surgery
  • being very nearsighted

Macular holes in children are rare. When they do develop, it is most likely due to a blow to the eye.

Learn more about vitreous detachment.

Doctors can diagnose macular holes with a test called optical coherence tomography (OCT). This uses light to create a three-dimensional cross-section of the back of the eye and hole if one is present.

Before carrying out OCT, a doctor may widen the pupil using eye drops to allow a better view of the back of the eye.

In some cases, doctors may also carry out a more involved test called fluorescein angiography. For this test, doctors inject patients with a dye and then take pictures of the back of the eye. The dye allows the doctors to examine how the blood circulates in this area.

Most macular hole cases require surgery, although some early stage cases may resolve without it.

The main way of treating a macular hole is with a surgical procedure called vitrectomy. This involves removing some or all of the gel that fills the eye, allowing a surgeon to repair damage to the macula.

After the procedure, the surgeon will replace the gel with either a saltwater solution or a bubble. Over time, the eye will make new fluid to replace it naturally.

A vitrectomy is more likely to be successful if a person has it within months of a macular hole developing.

After this procedure, people can usually go home on the same day. They may need to wear an eye patch or dressing to protect the eye while it heals.

People may need to take eye drops to reduce any swelling that may occur. Doctors may also prescribe some medication to help minimize discomfort.

If the surgeon puts a bubble into the eye to replace the gel, the patient will need to spend some time each day with their face down. This keeps the bubble in position and enables the eye to heal properly. The amount of time necessary will vary from person to person.

Some people may also need to avoid sleeping on their back after this surgery for the same reason. Their surgeon will be able to advise whether or not this is necessary.

Does a macular hole ever go away without treatment?

At the earliest stage, when it is small, a macular hole may heal without any treatment. This occurs in around half of cases in the earliest stage.

The outlook for a person with a macular hole depends on how quickly they receive treatment after their diagnosis. The earlier the treatment, the better the chances of a full recovery.

People with macular holes that do not have an apparent cause tend to have a better outlook than people with those that occur due to injury and have not healed on their own.

People with mild symptoms are also more likely to have their vision fully restored after treatment.

It can take a few months after treatment for an eye to recover and a hole to fully heal.

People should aim to speak with a doctor if their vision becomes blurred or distorted or if they develop a spot in their field of vision where they cannot see anything.

The likelihood of a successful recovery will be higher if a person receives treatment for a macular hole within a few months of its development.

Can a macular hole heal without surgery?

In some cases, a macular hole can heal without surgery. This may be more likely in the earliest stage of a macular hole. Some doctors may wait to see if this happens when they first speak with a patient.

Can someone with a macular hole still drive?

An eye doctor is best the person to decide whether or not someone with a macular hole can still drive. The degree to which a hole can disrupt vision varies from case to case.

How long does it take to recover from macular hole surgery?

It can take a few months for people to fully recover from vitrectomy surgery for a macular hole.

A macular hole is an opening that can develop in the center of the macula. This is the light-sensitive tissue at the back of the eye.

Macular holes can disrupt the center of a person’s field of vision. Objects may appear blurry or distorted, and eventually, there may be a central area where a person cannot see at all.

Many cases require a surgical procedure called a vitrectomy to treat them. If a person receives treatment promptly, the outlook for this condition is good, and many people will have restored vision afterward.