How it affects your vision

• Objects in the centre of vision may appear blurry or distorted.

• Straight lines may look bent or wavy.

• Some people notice only minor changes, while others experience progressive vision loss.

• Early, small holes can sometimes heal on their own, but larger holes usually require treatment.

• In fewer than 20% of cases, macular holes can develop in both eyes.

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Causes

In some cases, the cause is unknown. In others, a thin membrane on the retinal surface pulls the tissue apart, creating the hole. This is known as an epiretinal membrane.

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Treatment options

The most reliable treatment is surgery, performed by a specialist vitreoretinal surgeon.

• The procedure is usually done under local anaesthetic.

• The surgeon removes the eye’s natural gel (vitreous) and gently peels away any membrane pulling on the retina.

• A gas bubble is then inserted to help the hole close.

• Small stitches may be used, which dissolve within a few weeks.

After surgery, you will wear an eye pad and shield for one day.

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Benefits and risks

Benefits

• Around 80% of patients see an improvement or stabilisation in their vision.

Risks

• In 20% of cases, vision does not improve.

• Rarely, the hole may reopen (about 5% of patients).

• Other rare risks include retinal tear or detachment (1%), infection (<1%), or permanent sight loss (<1 in 1000 cases).

• Cataracts are common after this type of surgery but are easily treated.

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Recovery and aftercare

• Your eye may feel gritty, itchy, or look red for 1–2 weeks.

• Eye drops are prescribed to reduce inflammation and prevent infection.

• Do not rub your eye.

• Vision will be poor immediately after surgery due to the gas bubble, but it improves as the bubble shrinks.

• To help the bubble press against the macula, you will need to lie face-down for about 7 days.

• You must not fly or have nitrous oxide (“gas and air”) until the bubble has completely disappeared.

• Different gases remain in the eye for different lengths of time (2–12 weeks). Your surgeon will tell you which type was used.

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When to seek urgent help

Contact your care team immediately if you experience:

• Severe pain not eased by paracetamol

• Headache, nausea, or vomiting

• Sudden worsening of vision

• Increasing redness of the eye

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General advice after surgery

• Use eye drops as directed

• Rest and avoid strenuous activity or heavy lifting for 3 weeks

• Reading and watching TV are fine in moderation

• Showering is allowed, but avoid soap or water in the eye

• Wear sunglasses if they make you more comfortable

• Do not drive until cleared at your follow-up appointment

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Further information:

• British & Eire Association of Vitreoretinal Surgeons