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.