Retinal Hole

Retinal Hole
SYMPTOMS Typically asymptomatic but may experience floaters and/or flashes
SIGNS Atrophic retinal hole: A round red lesion that is anywhere from pinpoint to 2DD in size in the peripheral retina. There may be a white-gray cuff surrounding the round red lesion that represents edema or RPE pigment surrounding the round red lesion that represents stability/chronicity. There should be no evidence of vitreoretinal traction
Operculated retinal hole: A round red lesion that is anywhere from pinpoint to 2DD in size in the peripheral retina with an associated operculum (represents retinal tissue) floating in the vicinity. There may be a white-gray cuff surrounding the round red lesion that represents edema or RPE pigment surrounding the round red lesion that represents stability/chronicity. There should be no evidence of vitreoretinal traction
WORK-UP Full eye exam with dilated retinal exam, Scleral depression, Peripheral 90D, Gonioscopy 3-mirror (using retina mirrors)
TREATMENT Typically, no treatment is needed and retina needs to be monitored with the following: Atrophic retinal hole without symptoms / Atrophic retinal hole surrounded by RPE pigment / Multiple atrophic retinal holes without symptoms / Atrophic retinal hole with a surrounding fluid cuff of edema that is < 1 DD in size
Typically, no treatment is needed and retina needs to be monitored with the following: Operculated retinal hole without symptoms / Operculated retinal hole surrounded by RPE pigment / Multiple operculated retinal holes without symptoms / Operculated retinal hole with a surrounding fluid cuff of edema that is < 2 DD in size
Refer to a retinal specialist ASAP if patient presents with the following: Atrophic retinal hole with symptoms / Atrophic retinal hole with a surrounding fluid cuff of edema that is greater than or equal to 1 DD in size / Atrophic retinal hole with a history of a retinal detachment in either eye
Refer to a retinal specialist ASAP if patient presents with the following: Operculated retinal hole with symptoms / Operculated retinal hole with a surrounding fluid cuff of edema that is greater than or equal to 2 DD in size / Operculated retinal hole with a history of a retinal detachment in either eye
FOLLOW-UP Atrophic or Operculated retinal hole surrounded by RPE pigment: See patient back in 12 months
Atrophic or Operculated retinal hole without symptoms: See patient back in 6-12 months
Multiple Atrophic or Operculated retinal holes without symptoms: See patient back in 6 months
Atrophic retinal hole with a surrounding fluid cuff of edema that is < 1 DD in size: See patient back in 3-6 months
Operculated retinal hole with a surrounding fluid cuff of edema that is < 2 DD in size: See patient back in 3-6 months
If patient was seen and treated by a retinal specialist and the retina is stable, the patient should be seen back in 6-12 months
ADDITIONAL LAB | TESTS None
ETIOLOGY Atrophic retinal hole: Focal loss of retinal tissue due to retinal thinning and atrophy such as with lattice degeneration
Operculated retinal hole: Focal loss of retinal tissue that occurs secondary to traction and subsequent release of that traction. An operculum will be present as there is no longer any attachment to the retina
DIFFERENTIAL DX Retinal tear, Dot/Blot hemorrhage, Retinal detachment
NOTES About 7% of atrophic holes have the potential to eventually develop into a retinal detachment
The presence of a fluid cuff around the retinal hole could represent intraretinal edema or a subclinical sensory retinal detachment
The presence of RPE pigment surrounding a retinal hole indicates presence and stability of the retinal hole for at least 3 months
The size of an operculum will shrink over time and will look smaller than the actual size of the retinal hole
Retinal Holes: Retinal photo demonstrating an operculated retinal hole with a fluid cuff of edema https://www.reviewofophthalmology.com/article/evaluation-and-management-of-pvd

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