AIM: To investigate the association between visual handicap, laterality, and historical eye dominance in patients presenting with unilateral full thickness macular holes (FTMH). METHODS: Consecutive patients presenting with unilateral FTMH and no other visually significant ocular pathology including abnormalities of binocular vision were included. A questionnaire and case note review were performed to determine the mode of presentation, presence of symptomatic binocular interference, historically dominant eye, and whether they elected to undergo surgery. RESULTS: 44 eyes of 44 patients fulfilled the inclusion criteria. 21 (48%) affected eyes were right sided and 56% of FTMH were in the historically dominant eye. 76% of FTMH in historically dominant eyes presented symptomatically compared to 36% in non-dominant eyes (p= 0.003). 72% of patients with FTMH affecting their historically dominant eye were aware of binocular interference in day to day binocular viewing compared with 21% when the FTMH was in the non-dominant eye (p= 0.001). 23 (52%) patients elected to undergo surgery, of whom 18/23(78%) had FTMH in their historically dominant eye (p= 0.0003). CONCLUSION: This study suggests that eye dominance may be an important determinant of the visual handicap suffered by patients with unilateral FTMH.