Age is the biggest risk factor for developing a macular hole. As you get older, the vitreous, a jelly-like substance that fills the interior of your eye, begins to shrink and pull away from the retina. Usually, this does not cause any problems. But sometimes, the vitreous can stick to the retina, so when it begins to pull away, it causes the macula to stretch, then tear to form a hole.
Other eye disorders can cause swelling of the macula and this can sometimes cause a hole to appear. Macular holes can also occasionally be caused by an eye injury.