It remains controversial whether there is a significant genetic contribution to the pathogenesis of idiopathic giant retinal tears or retinal dialysis. In contrast, the underlying molecular genetic basis of several inherited vitreoretinal dystrophies is now well established, with also an increasing recognition of genetic factors in the development of myopia. We describe asymptomatic female monozygotic twins who were identified as having identical retinal holes. These cases represent the first evidence to our knowledge of a potential role of inherited factors in the causation of idiopathic peripheral retinal holes. This observation raises the need to examine the twin of any patient presenting with a retinal break(s).