Posterior Segment
Retinal Hole (Atrophic and Operculated)
Also known as: retinal hole, atrophic retinal hole, atrophic hole, operculated hole, operculated retinal hole, round hole, peripheral retinal hole, asymptomatic retinal break
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A round full-thickness break in the peripheral retina found in a patient without symptoms. An atrophic hole comes from retinal thinning and is probably unrelated to vitreous traction. An operculated hole forms when localised traction pulls a plug of retina free, which usually releases the traction. Both rarely lead to detachment and are reviewed at an interval set by the fluid cuff and how long the hole appears to have been present. A cuff more than 1 disc diameter in radius, extra risk factors for detachment, or any symptoms change the pathway to referral. A flap or horseshoe tear is a different lesion and belongs to the retinal tear record.
Recognition
Symptoms: what patients report
- None: the hole is found at a dilated examination or on widefield imaging.
- New flashes, floaters, a curtain or a field defect make this a symptomatic break and need same-day assessment.
Signs: what the examination shows
- Atrophic hole: a red, round lesion, often inside lattice or snail-track degeneration; no flap and no operculum.
- Operculated hole: a round red hole with a fragment of tissue floating in the vitreous over it; the fragment often looks smaller than the hole because it has shrunk.
- A cuff of subretinal fluid may surround either type. Measure its radius in disc diameters.
- Pigment hyperplasia around the hole suggests it has been there a long time.
- OCT (where the lesion can be reached): a full-thickness break.
- Anterior vitreous clear of pigment cells in an uncomplicated hole.
What OptoGuide™ covers for retinal hole (atrophic and operculated)
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting