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What Are Lacquer Cracks?

Lacquer Cracks are mechanical breaks in the deeper layers of the retina, specifically involving Bruch's membrane, the Retinal Pigment Epithelium (RPE), and the choriocapillaris. They are a hallmark sign of Pathologic Myopia (degenerative nearsightedness). As the name suggests, they look like fine, irregular branching lines that resemble the cracks seen in old lacquer varnish on wood or pottery. They typically appear yellowish-white and are usually found in the posterior pole (the back center) of the eye. They represent a physical snapping of the tissue because the eye has grown too large for its internal layers to handle.

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What Are Lacquer Cracks?

Lacquer Cracks are mechanical breaks in the deeper layers of the retina, specifically involving Bruch's membrane, the Retinal Pigment Epithelium (RPE), and the choriocapillaris. They are a hallmark sign of Pathologic Myopia (degenerative nearsightedness). As the name suggests, they look like fine, irregular branching lines that resemble the cracks seen in old lacquer varnish on wood or pottery. They typically appear yellowish-white and are usually found in the posterior pole (the back center) of the eye. They represent a physical snapping of the tissue because the eye has grown too large for its internal layers to handle.

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Mechanism: The Elongated Globe

The root cause of lacquer cracks is axial elongation. In high myopia, the eyeball grows excessively long (like an egg instead of a sphere). The outer wall (sclera) stretches to accommodate this growth. However, the layer sandwiched between the retina and the sclera, known as Bruch's membrane, is elastic but brittle. When the stretching force exceeds the membrane's tensile strength, it snaps. This rupture heals with scar tissue, but the crack remains permanent. It is essentially a stretch mark on the inside of the eye.

The CNV Risk (Myopic Macular Degeneration)

While the cracks themselves usually do not cause severe vision loss unless they run directly through the center of vision (the fovea), they are a major warning sign. A lacquer crack represents a breach in the barrier between the blood-rich choroid and the retina. This creates a pathway for abnormal blood vessels to grow through the crack, a condition called Choroidal Neovascularization (CNV). In high myopia, this often leads to a sudden bleed or a dark spot in central vision known as a "Fuchs spot." This is one of the leading causes of visual disability in young adults with high myopia.

Prognosis and Monitoring

There is currently no treatment to repair a lacquer crack once it has formed. The management is strictly monitoring. The presence of these cracks classifies a patient as having "Pathologic Myopia," shifting them from routine eye care to medical retinal monitoring. Doctors watch carefully for any signs of bleeding or waviness in vision. If new vessels grow through a crack, anti-VEGF injections are used to stop the bleeding and preserve vision.

The Coin Hemorrhage (Simple Bleeding)

Not all bleeding associated with lacquer cracks means the patient has developed wet macular degeneration. Occasionally, the mechanical force of the crack forming can rupture a small capillary, causing a "simple hemorrhage" or "coin hemorrhage." This presents as a round, focal bleed centered over the crack. While it causes a sudden blind spot, it is distinct from CNV because there is no network of abnormal vessels growing. These simple hemorrhages typically have a good prognosis and the blood reabsorbs spontaneously without requiring injections, provided no CNV is present.

FAQs on Lacquer Cracks

Do they hurt?

No. The formation of a lacquer crack is painless. A patient might not even know they have them until a doctor sees them during a dilated exam.

Can LASIK fix them?

No. LASIK reshapes the front of the eye (cornea). Lacquer cracks are at the very back of the eye. Having LASIK does not reduce the risk of retinal complications associated with having a long eye.

Does every nearsighted person get them?

No. They are typically seen in eyes with high myopia (usually greater than -6.00 or -8.00 diopters) or in eyes with an axial length greater than 26.5 mm. Mild nearsightedness rarely causes enough stretching to break the membrane.

When to See Your Eye Doctor

If you are highly nearsighted and notice a sudden, fixed dark spot in your central vision or if straight lines (like door frames) suddenly look wavy or bent, you need an urgent retinal exam to check for bleeding associated with these cracks.

References

https://eyewiki.aao.org/Pathologic_Myopia https://pubmed.ncbi.nlm.nih.gov/25568067/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688415/ https://retinatoday.com/articles/2016-mar/myopic-choroidal-neovascularization