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eccentric fixation

Eccentric fixation is a monocular condition in which a point of the retina other than the foveola is used for fixation when the other eye is covered. It develops in a constant, one-sided strabismus of long standing during the years of visual development.1,2

In true eccentric fixation the sense of straight ahead has moved to the new point, so the patient believes they are looking directly at the target.1,2 Acuity falls in step with the distance from the fovea, and the condition is graded with the fixation target of a direct ophthalmoscope or with Haidinger's brushes.1,3

Eccentric fixation differs from eccentric viewing, in which a patient with a central scotoma deliberately looks beside a damaged fovea that still owns the sense of straight ahead.4

More detail

Acuity is roughly 20/30 at one degree of eccentricity, 20/40 to 20/50 at two degrees and 20/50 to 20/60 at three degrees.3 The largest eccentricity seen in clinic is about 3 to 4 prism diopters.3 Fixation in amblyopia is classed as central, eccentric (near the foveola, just outside the fovea, or peripheral) or absent.2 An esotropic eye fixates nasal to the fovea and an exotropic eye temporal to it, while the reverse pattern is paradoxical eccentric fixation.1 Eccentric fixation is rare in amblyopia caused by anisometropia alone, and its presence worsens the prognosis for amblyopia treatment.1

Sources (8)
  1. Pickwell's Binocular Vision Anomalies, ch. 13, Amblyopia, and glossary
  2. von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 14
  3. Duckman, Visual Development, Diagnosis, and Treatment of the Pediatric Patient
  4. AOA, Care of the Patient with Visual Impairment, glossary
  5. Rutstein, R., Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management, Mosby.
  6. Tarita-Nistor, L., González, E. G., Markowitz, S. N., & Steinbach, M. J. (2008). Plasticity of fixation in patients with central vision loss. Visual neuroscience, 25(5-6), 755-766.
  7. Crossland, M. D., Culham, L. E., Kabanarou, S. A., & Rubin, G. S. (2005). Preferred retinal locus development in patients with macular disease. Ophthalmology, 112(9), 1579-1585.
  8. Nilsson, U. L., Frennesson, C., & Nilsson, S. E. (2003). Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope. Vision research, 43(16), 1777-1787.

Reviewed October 2026

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