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Retinal holes - unnoticed heralds of retinal detachment
A retinal hole (retinal foramen) or retinal tear in the eye can appear almost without symptoms or pain. In this way, these affections of the retina (retina) often go unnoticed. Without appropriate treatment, however, there is a risk of retinal detachment (amotio retinae, ablatio retinae). Early diagnosis and treatment is extremely important in order to prevent serious consequences for eyesight and even blindness. Regular eye examinations are advisable for people of advanced age and under certain risk factors.
A brief overview
A hole or tear in the retina is often not noticed by those affected, but is a serious change in the retina that threatens vision. The following brief overview provides important information to enable early detection and treatment. The article also contains detailed descriptions of the clinical picture, such as the causes, symptoms and treatment options.
Eye problems - how to spot a retinal hole and what to do
Affected people often notice a retinal hole or a tear late. This pain-free damage to the retina often remains completely symptom-free, especially in the early stages. Signs that can indicate retinal holes are various disturbances in visual perception that appear as moving opacities or images in the visual field. These are often described as follows:
- Fog, smoke or shadows,
- "Flying mosquitos" (dancing black dots),
- "Soot rain" (black dots falling),
- Flashes (with eyes closed).
If such symptoms occur, an ophthalmological examination should be carried out immediately. With the appropriate diagnosis, the earliest possible treatment is an important criterion for maintaining vision. In the advanced age and for people who suffer from diabetes mellitus or suffer from myopia, regular check-ups of the eyes are advised.
The retina, called retina in Latin, is located on the inside of the eyeball. It is pressed against the choroid through the vitreous and only loosely adheres to it through so-called adhesive forces. Only in the area of the optic nerve and the external retinal circumference are the veins and retinas grown together. At these marginal areas, the retina can have thin spots that are referred to as retinal degeneration. Due to different causes, these areas are particularly susceptible to holes and tears or even retinal detachment.
The retina consists of several layers, each of which has different functions. Taken together, it captures the incoming light and the complex light information, sorts it, and converts it into nerve impulses. The preprocessed visual information is then passed on to the brain via the optic nerve. The retina therefore plays a special role in visual perception. Damage or degeneration can severely impair vision.
As a rule, damage to the retina is not associated with pain. The existing nerve fibers do not transmit pain information to the brain, but transmit other impulses. Small openings in particular can initially remain completely symptom-free. Most of the time, however, the first damage worsens and then various complaints arise in the further course.
Symptoms that indicate retinal holes are mainly disturbances in visual perceptions. Usually only one eye is affected. If a hole or tear occurs, small blood vessels are often damaged and bleeding occurs, which can cause various types of images and moving cloudiness in the view. The following symptoms are often described by those affected:
- fog or smoke-like shadows in the visual field, which are perceived as black or red images,
- black, dancing spots in front of the eyes ("flying mosquitoes"),
- lightning flashes with eyes closed,
- descending black dots ("soot rain").
If there is heavy bleeding, eyesight may also be impaired to a greater extent. If the macula (Macula lutea) is damaged, reduced visual acuity is to be expected. The macula is also known as the "yellow spot" and is a very small part in the rear, central area of the retina. In this tiny area there is a very high density of photoreceptive cells, which ultimately ensure sharp and focused vision.
If eye fluid gets under the retina, a real retinal detachment can result from a hole or tear and there is a risk of complete loss of vision.
Most often, holes and tears in the retina are caused by the so-called posterior vitreous detachment. This means a lifting of the soft inner body of the eye, together with the vitreous membrane, in the rear area of the retina. This is often triggered by age-related shrinkage of the vitreous and is therefore not a pathological process.
However, pronounced visual disturbances, such as severe myopia, increase the risk of damage to the retina. An elongated eyeball can be the reason for this poor eyesight. This is accompanied by a correspondingly stretched and partially thinned retina, which statistically shows degenerations, holes and tears more frequently. Furthermore, injuries to the eye area or previous cataract surgery can increase the risk of damage to the retina. In addition, genetic factors or the presence of diabetes (diabetes mellitus) also promote the occurrence of retinal damage (diabetic retinopathy).
The vitreous consists of 98 percent water and fills the inside of the eyes in childhood. With the age-related shrinkage of the vitreous body, the vitreous body gradually collapses due to increasing water loss and there are various tensile forces on the retina. Holes or tears can then occur in certain areas of the retina, in particular in thinner areas and the contact points with the vitreous body.
Changes in the retina can only be diagnosed by a thorough ophthalmological examination. In order to be able to examine the fundus of the eye, non-invasive mirroring (ophthalmoscopy or fundus copy) is usually carried out. But digital retinal exams are also offered these days.
With the classic form of eye mirroring, there is a direct and an indirect examination method. For both variants, the pupil is dilated with medication by administering eye drops. As a rule, the further examination takes place in a darkened room. An electric light beam is then directed through a pupil through the pupil directly onto the retina to illuminate the fundus. A magnifying glass or a contact glass are used to make the structures and possible changes in maximum magnification clearly recognizable. A contact glass is placed on the eyeball and a surface anesthetic is required in advance.
In direct ophthalmoscopy, the examination is carried out from a distance of approximately ten centimeters; with the indirect method, the distance is about half a meter. A larger distance means less detail view, but a better overall view of the eye.
If bleeding in the vitreous is blocking the back of the eye, an ultrasound scan can also be used. This method is painless and enables quick and detailed information about changes in the retina. It is also possible to recognize the nature of a detachment and to delimit similar-looking clinical pictures.
Regular ophthalmological checks, especially from the age of 40 and in people with an increased risk, are used for the early detection of damage to the retina. Otherwise, these could go unnoticed and could result in serious visual disturbances or even blindness.
The earlier the damage is recognized and the smaller it is, the greater the success of the treatment. Early therapy minimizes the risk of retinal detachment. However, there is no possibility of drug treatment, and the openings cannot be closed directly in any other way. If there is a diagnosis of a retinal hole or a tear, an attempt is made to create the conditions for the hole to close again.
Outpatient laser treatment (laser coagulation) is used most frequently, and particularly in the case of very small holes and without detachment of the retina. With a targeted laser beam, stable scarring of the retina with its base, the choroid, is created in the area of the defect edges. This type of "welding" of the two layers is intended to bring about permanent sealing.
If there is major damage, cold treatment (cryocoagulation) can be used to seal the edges. With the help of a cold probe, the affected areas are cooled down considerably. Larger scars are also formed here, which should guarantee a stable seal.
Since the treatments are somewhat uncomfortable, local anesthesia usually takes place with both methods. The treated patients should take care of themselves for up to ten days afterwards and, for example, avoid doing sports. During this time, the lasered area scarred and ensured permanent sealing. In most cases, the therapy is successful and the eyesight is restored without further impairments. However, it cannot be completely ruled out that the treatments will cause further injuries with bleeding, infections or other reactions that affect the success of the therapy.
In the late stage or in very complicated cases, which are usually accompanied by a (partial) detachment of the retina, only a surgical intervention can make it possible to maintain vision. Unfortunately, with these severe forms, even with successful treatment, there is still a risk of a significant decrease in vision up to blindness.
Existing damage to the retina always requires specialist medical care. If one considers the connection with signs of aging or diabetes mellitus, preventive measures from the field of naturopathy can reduce the risk of developing retinal damage.
The approach of orthomolecular medicine (OM) is used here in particular. This form of therapy is based on the administration of antioxidant and blood circulation-promoting substances. Various products that contain certain minerals, vitamins and other important nutrients are said to have a supportive effect on general health and, among other things, on the preservation of the eyes and retina. Age-related symptoms or diabetic retinopathy and various other indications require a well-founded consultation before taking the appropriate nutritional supplements. Self-medication is strongly discouraged. In principle, adequate hydration (especially in the form of water) is health-promoting in many ways, including for the eyes. (jvs, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Lang, Gerhard K .: Ophthalmology, Thieme, 6th edition, 2019
- Grehn, Franz: Ophthalmology, Springer, 31st edition, 2012
- National Eye Institute (NEI): Facts About Macular Hole (accessed: July 9, 2019), nei.nih.gov
- American Academy of Ophthalmology: What Is a Macular Hole? What causes a macular hole? (Accessed: 09.07.2019), aao.org
- National Health Service UK: Macular hole (accessed: 09.07.2019), nhs.uk
- Mayo Clinic: Retinal diseases (accessed: July 9, 2019), mayoclinic.org
ICD codes for this disease: H33ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.