Which of the following characteristics would LEAST likely favor the likelihood of a patient developing Eccentric fixation?

• A. Constant strabismus
• B. Unilateral strabismus
• C. Large angle strabismus
• D. Longstanding duration strabismus

Answer: (C)

Eccentric fixation happens when the brain fixes images using a nonfoveal part of the retina, usually because the fovea of one eye is suppressed due to strabismus or amblyopia. The eye stays misaligned, and over time the visual system adapts by relying on a parafoveal point in the deviated eye to maintain single vision.

If strabismus is constant and unilateral with a long duration, the brain repeatedly suppresses the fovea of the misaligned eye and develops an eccentric fixation point to keep using that eye. This neural adaptation is most likely when the misalignment is persistent, the suppression is focused on one eye, and there’s ample time for the system to adapt.

In contrast, when the deviation is large, suppression tends to be more complete, and the fellow eye often takes over fixation entirely. With such a substantial misalignment, there’s less opportunity or need for the deviated eye to use an eccentric retinal point for fixation, making eccentric fixation less likely.

So the characteristic least likely to favor eccentric fixation is a large angle strabismus.