By:Sunimol Chacko

Third year B. optometry

What is FIXATION???
When a normal eye fixates, the image of

fixation object falls on the retinal foveola.

Bangerters classification of
fixation:
1. CENTRAL FIXATION
2. ECCENTRIC FIXATION
3. NO FIXATION

Central as well as nonfoveolar fixation may be

steady or wandering.
Wandering fixation which occurs only after
covering the sound eye must be distinguished
from the monocular, spontaneous, pendular
and vertical oscillations that are occasionally
found in the amblyopic eyes.

Generally in esotropia there is nasal

eccentricity ; and in exotropia there is

temporal eccentricity seen.
But can be reversely seen in PARADOXICAL
FIXATION BEHAVIOUR.

ECCENTRIC FIXATION
A failure of an eye in monocular vision to take

up fixation with the fovea but with some other

point i.e an area outside the foveola.

Eccentric fixation can be present during both

monocular and binocular viewing conditions.

But can be best diagnosed under monocular
viewing.

CLASSIFICATION
Eccentric fixation is classified according to the

retinal area used:1. PARAFOVEOLAR

2. PARAFOVEAL
3. PERIPHERAL

PREVALANCE
In a study it was published (1975-1976)
44% had eccentric fixation off 433 amblyopic

patients with strabismus.

In anisometropic amblyopia eccentric fixation
was encountered only rarely.
Recent studies state that treating amblyopia
at an very early age can not only treat
amblyopia but can also make eccentric
fixation less frequent.

EXAMINATIONS

FIXATION
OPHTHALMOSCOPE
Fixation target is incorporated into the
ophthalmoscope beam.
Target varies with the type of
ophthalmoscope.
Target must be easily seen by the examiner
as well as the patient.
Target must be small enough to allow
identification of foveola.

Visuscope
It is a modified ophthalmoscope.
It projects a fixation target on the fundus.
The eye not tested is to be occluded.
Examiner projects the fixation mark close to

the fovea and the patient is asked to look

directly on the target.
The position of the fixation target on the
fundus is to be noted.

VA depends upon
The area of retina being used for fixation.
Stability or instability of the fixation.
Superimposed amblyopia.

Although eccentric fixation is usually

considered to be a uniocular condition, the

occurrence of bilateral eccentric fixation has
been reported and its presence should be
suspected in cases of bilateral amblyopia due
to ametropia or other causes such as macular
abnormalities.

Fundus photography
This method provides a record and can show

if fixation ranges over a retinal area.

Other examinations
Corneal reflex test
Bjerrum screen method
Amsler chart
Haidingers brushes
Pinhole
Neutral density filter test

Assessment of fixation
Centricity of fixation.
Quality of fixation
Pattern of fixation.
Direction of fixation.

General Characteristics
Small angle
Anisometropia
Amblyopia
Eccentric fixation
Harmonious ARC

Diagnosis
Visual acuity
Fixation
Cover test
4D prism test

Treatment
Refractive error correction
Contact lens correction
Treat amblyopia by occlusion of non squinting

eye.
In pts more than 6 years of age correct the
refractive error
Surgery is not appropriate.

REFERENCES
DIAGNOSIS AND MANAGEMENT OF OCULAR

MOTILITY DISORDERS THIRD EDITION.. ALEC M

ANSONS AND HELEN DAVIS. Page no
58,59,60,61..222.
Optometry today .. ROXANNA POTTER PAGE
NO 10
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