A Mechanism for Spontaneous Closure of a Traumatic Macular Hole with Commotio Retinae in a Pediatric Patient

Several theories have been proposed for the development of idiopathic macular holes, including the cystoid degeneration theory, the vitreous theory, and involutional macular thinning [1]. While is it now understood that the majority of idiopathic macular holes fall into one of these categories, we will discuss a case of a traumatic macular hole arising from blunt ocular trauma and propose a mechanism for the formation and closure of the traumatic macular hole. In describing the pathogenesis of traumatic macular holes, it has been found that force of impact transmitted to the posterior pole can cause rupture of the delicate foveal tissue [2]. In addition, commotio retinae (retinal edema and opacification due to the degeneration of receptor cells in the outer nuclear layer) often occurs concurrently due to the force of trauma transmitting shock waves across the retina. It is believed that the damage from this commotio can be reversible [3,4].