Monofixation syndrome is characterized by central foveal suppression in one eye despite maintained peripheral fusion. It is caused by mild retinal image blur or misalignment between the eyes. The macula has high spatial resolution making the brain sensitive to small interocular differences, leading to central suppression in one eye, while the lower resolution periphery allows fusion. The size of the central scotoma corresponds to the degree of interocular image disparity. Clinical features include a small-angle strabismus, anisometropic amblyopia, and a unilateral central scotoma only present binocularly.

1. Monofixation syndrome

2. • It is characteriszed by central sensory foveal
suppression in one eye with maintained
binocular fusion with peripheral visual field.
• Its caused by mild to moderate degree of
unilateral retinal image
blurr.(anisometropia),small degree of
microtropia of less than 10PD,

3. • Why there is only monocular central suppression in
one eye??
• It is because central macula and fovea has small
receptive field and potentially high spatial resolution
that make brain more sensative even for small
diffrencess in interaocular visual inputs on the basis of
image clarity or retinal image position between the
two eyes,
• but in case of peripheral retina that has larger
receptive visual vield but low spatial resoultion that
allow for lager degrees of retinal image discrepancy, so
that its able to maintain pheripheral fusion,

4. • The size of the central suppression scotoma is
directly proportional to the degree of
interocular image disparity,if there is severe
unilateral image blurr fro eg.demse cataract or
larger angle starbismus that is greater than
the amount of image disparity that allow for
fusion in the peripheral visual
fields,supression of visual input from entire
eye may occurs and amblyopia may develop.

5. Clinical features
• Small ange starbismus less than 10PD
• Anisometric amblopia
• Unilateral astigmatism
• Partial or mild media opacity like cataract.
• Steroacutiy in range of 3000-7000arc seconds
• Unilateral central scotomais usually betwin 2-5 degree of
visual field (NOTE=this is facultative scotoma)its only
present under binocular condition and as soon as dominate
fixating eye is closed the central scotoma of non dominat
eye vanishes,
• So its monocular problem but manifested binolulary
• Pt with MFS have some degree of mild to sever amblyopia

6. Clinical testing
• Bagolini lenses

7. • Worth4 dot test