Macular Hole vs. Macular Pseudohole

Medically Reviewed by Whitney Seltman, OD on September 27, 2022
Written by Marijke Vroomen Durning, RN
4 min read

The macula is the center part of your retina. It gives you your central vision, what you see right in front of you. When the macula is damaged, you can still see around the edges of your vision, peripherally, but not straight ahead. There are several conditions that can affect your macula, including macular holes and pseudoholes. Both conditions are rare and although they are different diagnoses, they do have a lot in common.

Macular holes and macular pseudoholes are not related to age-related macular degeneration, a condition caused by thinning or damage to the macula.

Macular holes most commonly appear as we age and the gel-like fluid in our eyes starts to shrink. As it contracts, the gel pulls away from the retina. But if the gel is stuck to the macula, the gel pulls at it and can cause a macular hole.

Other causes include:

  • Eye injuries
  • Eye diseases that cause macular swelling, most commonly diabetic retinopathy
  • Eye surgery
  • Some medications

Pseudoholes are also caused by pulling, or traction, but the pull isn’t as strong as it is for a macular hole. Instead, pseudoholes happen when tissue called the epiretinal membrane pulls in. This compresses or wrinkles the layers instead of making a hole. Pseudoholes can seem like macular holes at first and cause some of the same symptoms. Although it’s not common, a pseudohole could become a hole.

Anyone can get a macular hole, but you may be at higher risk if you are:

You may also be at risk if you have:

  • A condition that causes macular swelling
  • A macular pucker, a wrinkle or crease in the macula
  • Had an eye injury
  • Had eye surgery
  • A macular hole in one eye already

Macular hole symptoms usually come on gradually and you may not notice them at first, especially if you have no problems with your other eye.

Macular hole symptoms include:

  • Blurriness in the center of your vision
  • Lines may look wavy or distorted, close or far
  • Difficulty seeing close tasks, like reading or writing

Eventually, you may notice pieces of the image in front you are missing and you see a dark spot instead. For example, if you look at a keyboard, you may not see the keys that should be in the middle of your view, but you can see the ones along the sides, above, and below.

Pseudoholes also cause blurring and distortion, but not as badly as macular holes.

An ophthalmologist or optometrist (eye doctor) can tell you whether you have a macular hole or pseudohole with a test called optical coherence tomography (OCT). The doctor might use eye drops to dilate your pupil before the test, but not always.

If you have a macular hole or pseudohole and it isn’t interfering with your vision, your doctor may advise you to “watch and wait” to see if it gets worse. This would mean having more frequent vision tests. But these holes can’t go away on their own. They must be treated eventually before you lose too much of your vision.

Treatment for a macular hole involves surgery called a vitrectomy. Your eye is numbed and an ophthalmologist removes the gel, replacing it with air or a gas bubble that flattens the hole and allows the eye to heal.

This surgery may also be done to fix a pseudohole if it has a big impact on your vision.

Recovery from macular holes or pseudoholes can take a year or even longer. But the results are usually good. Someone on your health care team will give you post-surgery instructions. And it’s important to follow them to get the best outcome.

Those directions will likely include:

  • Take recommended pain relievers as needed.
  • Wear an eye patch for as long as directed.
  • Use prescribed eye drops as directed.
  • After the surgery, keep your face in a certain position to keep the gas bubble in place. Most of the time, this means lying face down. Ask your doctor how long you’ll need to do this. And it’s a good idea to ask what you should do about necessities, like going to the bathroom.
  • Avoid heights or situations where your eye is exposed to extra pressure, like flying in a plane or scuba diving, until your doctor says it is safe.

Be sure to tell any other health care professionals that you have this gas bubble in your eye before they do any procedures, including surgery.

A vitrectomy is generally a safe operation, but there are some risks, such as:

Talk with your ophthalmologist about any concerns and what to watch for after your surgery.