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visual confusion

Visual confusion is the perception of two different objects in the same place. Dissimilar images fall on corresponding retinal points of the two eyes, such as the foveae, and the visual system localizes both images to the same spatial location.1 In strabismus, the fovea of the fixating eye receives the image of the object of regard, and the fovea of the deviating eye receives the image of whatever lies on its own visual axis.2 The two foveal images are superimposed and projected to the same point.2

Visual confusion differs from diplopia, which occurs when the image of one object stimulates noncorresponding points in the two eyes.1,2 The onset of strabismus in a visually mature patient produces diplopia, visual confusion and loss of stereopsis.1 Patients seldom report confusion voluntarily, but those who notice the overlap of the foveal images find it very distressing.3 Suppression is the visual system's defense against diplopia and visual confusion, and suppression develops more rapidly and completely the younger the child at onset.1 Central suppression overcomes confusion, and peripheral suppression overcomes diplopia.2

More detail

Simultaneous stimulation of corresponding retinal areas by dissimilar stimuli prevents fusion, and both stimuli are localized in the same visual direction.4 The visual system resolves the resulting conflict by temporarily suppressing one image or the other.4 Diplopia is the more common complaint, but some patients with acquired strabismus find visual confusion or loss of stereopsis equally or more disruptive.1

Sources (23)
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  2. Eperjesi and Rundström, Practical Binocular Vision Assessment, ch. 7
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  4. von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 2
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  6. Buffenn, A.N. (2020). Diplopia and Strabismus. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_291-1
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  8. Horton Lab - UCSF. (2013). Strabismus and Visual Suppression. [online] Available at: https://hortonlab.ucsf.edu/blog/strabismus-and-visual-suppression [Accessed 6 May 2024]. secondary
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  23. Springer: 978-3-030-42634-7_291

Reviewed October 2026

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