ConditionEyes & vision
Posterior Staphyloma
A posterior staphyloma is an outward bulge of the back wall of the eye (the sclera), where the eye has stretched abnormally. It is a hallmark of pathologic myopia, severe nearsightedness usually above -6 to -8 diopters with a long eyeball. The staphyloma itself causes no pain, but the thinned, stretched retina inside it is prone to damage: myopic maculopathy, abnormal blood vessel growth, retinal splitting and detachment. There is no way to reverse it, so regular eye exams and prompt treatment of complications protect vision.
Also called: Staphyloma of the eye, myopic staphyloma, scleral staphyloma
At a glance
- What it is
- An outpouching of the back of the eye where the sclera has thinned and stretched.
- Who gets it
- Mainly people with high or pathologic myopia, more common with age.
- Symptoms
- None from the bulge itself. Complications cause blur, distortion and vision loss.
- Detection
- Dilated eye exam, OCT and wide-field imaging.
- Treatment
- Monitoring, anti-VEGF injections for new vessels, and surgery for retinal detachment or splitting.
When to get help
Call 911 or go to the ER
- A curtain or shadow spreading across your vision, or a sudden shower of floaters with flashes (possible retinal detachment)
- Sudden loss of vision in one eye
See a doctor within a day or two
- Straight lines suddenly looking wavy or bent, or a new dark or gray spot in central vision (possible myopic choroidal neovascularization)
- Gradual but noticeable decline in central vision over weeks
Book a routine appointment
- High myopia (stronger than about -6 diopters) without a dilated eye exam in the past 1 to 2 years
- Difficulty getting clear vision with new glasses
What happens in a posterior staphyloma
In high myopia, the eyeball grows too long from front to back. In pathologic myopia, the back of the eye stretches unevenly, and a region of the sclera thins and bulges outward, forming a staphyloma. The retina, choroid (the blood vessel layer) and sclera in that area become thin.
Staphylomas are classified by location, for example:
- wide macular: the most common, involving the central retina
- narrow macular
- peripapillary: around the optic nerve
- nasal or inferior
Who is at risk
- people with high myopia, typically -6 to -8 diopters or more, and long axial length (over about 26.5 mm)
- older adults, as staphylomas develop and deepen with age
- people of East Asian descent, where high myopia is especially common
- some genetic syndromes, such as Stickler and Marfan syndromes
Myopia is rising worldwide, especially in children who spend little time outdoors, which is expected to increase the number of people with pathologic myopia.
Symptoms
The staphyloma itself is painless and often unnoticed. Vision problems arise from complications:
- gradually blurred central vision
- distortion (straight lines look bent)
- dark or blank spots in central vision
- difficulty seeing in low light
- floaters and flashes if the retina tears
Complications
| Complication | What happens | Symptoms |
|---|---|---|
| Myopic maculopathy | Thinning and atrophy of the macula, lacquer cracks | Slow decline in central vision |
| Myopic choroidal neovascularization | Abnormal blood vessels grow under the retina and leak | Sudden distortion, central dark spot |
| Myopic traction maculopathy (retinoschisis) | The retina splits into layers inside the staphyloma | Gradual blur and distortion |
| Macular hole | A full-thickness hole in the center of the retina | Central blind spot |
| Retinal detachment | Retina separates from the back of the eye | Curtain, flashes, floaters |
| Glaucoma | Optic nerve damage, harder to detect in high myopia | Usually silent until advanced |
Diagnosis
An ophthalmologist or retina specialist will:
- check vision and refraction
- examine the back of the eye after dilating the pupils
- use OCT (optical coherence tomography), which shows the shape of the eye wall, retinal splitting and fluid
- use wide-field imaging, ultrasound, or 3D MRI to map the staphyloma
- use fluorescein angiography or OCT angiography if new blood vessels are suspected
- measure axial length
Treatment
There is no treatment to reverse a staphyloma. Care focuses on vision correction and complications:
- Glasses or contact lenses for the best possible vision
- Anti-VEGF injections into the eye for myopic choroidal neovascularization. Often only a few injections are needed, and early treatment preserves vision.
- Vitrectomy surgery for symptomatic retinoschisis, macular hole or retinal detachment
- Laser for retinal tears
- Glaucoma treatment with drops, laser or surgery
- Posterior scleral reinforcement: a surgical procedure to support the back of the eye, used in some countries for progressive cases, with limited evidence
- Low vision aids if central vision is reduced
Slowing myopia in children
Since pathologic myopia begins as childhood myopia, slowing myopia progression in children may reduce future risk. Options include more time outdoors, low-dose atropine eye drops, and special myopia-control glasses or contact lenses, under the care of an eye specialist.
Outlook
Many people with a posterior staphyloma keep useful vision for years. The risk of complications rises with age and the severity of myopia. Regular monitoring and quick treatment of new symptoms, especially distortion or sudden changes, give the best outcomes.
Frequently asked questions
What is a posterior staphyloma?
It is an outward bulge of the back wall of the eye caused by thinning and stretching of the sclera. It occurs mainly in severe nearsightedness (pathologic myopia) and increases the risk of retinal damage.
Does a posterior staphyloma cause symptoms?
The staphyloma itself does not cause pain or obvious symptoms. Vision problems come from complications such as myopic maculopathy, abnormal blood vessels, retinal splitting or detachment, which cause blur, distortion or dark spots.
Can a staphyloma be fixed?
The bulge cannot be reversed. Treatment targets complications: injections for abnormal blood vessels, surgery for retinal detachment or splitting, and glaucoma treatment. Regular eye exams help catch problems early.
How is a posterior staphyloma diagnosed?
An eye specialist detects it during a dilated exam and confirms it with OCT scans, wide-field imaging or ultrasound. These tests also look for complications in the retina.
Can high myopia be prevented?
Not entirely, but its progression in children can be slowed with more outdoor time, low-dose atropine drops and special glasses or contact lenses. Slowing myopia may lower the chance of developing pathologic myopia and staphyloma later.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Pathologic myopia (EyeWiki)
- International Myopia Institute: White papers on pathologic myopia
- National Eye Institute (NEI): Nearsightedness (myopia)
- MedlinePlus (US National Library of Medicine): Nearsightedness
- World Health Organization: The impact of myopia and high myopia report