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Macular hole - External and Internal Eye
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Macular hole - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
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Synopsis

A macular hole is a defect of the neurosensory retina of the fovea that is usually idiopathic but may sometimes be due to trauma, including laser pointer exposure. Macular holes may be lamellar or full thickness. When associated with trauma, they are found in a younger age group with a stronger vitreous and tend to be larger. Idiopathic macular holes are found in 0.03% of the population, usually in older patients, with a higher prevalence in women (ratio of 3:1) and are bilateral in about 10% of patients. Patients with macular holes may complain of metamorphopsia and/or a central vision loss varying from 20/25 to 20/200. The early stages of a macular hole may be asymptomatic.

Vitreous tractional forces on the anatomically thin perifoveal region can lead to separation of the retinal layers. This can happen immediately after trauma or, more commonly, over months, leading to full-thickness macular holes.

Approximately 3% to 9% of macular holes close spontaneously over a 6-year period. The presence of a posterior vitreous detachment (PVD) decreases the risk of progression from an early macular hole to a full-thickness defect. Development of a macular hole in the fellow eye is also decreased in patients with a PVD in that eye. 

Codes

ICD10CM:
H35.349 – Macular cyst, hole, or pseudohole, unspecified eye

SNOMEDCT:
232006002 – Macular hole

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Epiretinal membrane with pseudohole 
  • Macular cyst 
  • Cystoid macular edema 
  • Solar retinopathy 
  • Central serous retinopathy 
  • Subfoveal drusen

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 07/10/2018
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Macular hole - External and Internal Eye
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