Visual search patterns in Unilateral Spatial Neglect: A review of eye-tracking evidence

Unilateral Spatial Neglect is a common neuropsychological condition following brain lesions, characterized by an attentional imbalance between the neglected (contralesional) and the preserved (ipsilesional) side of the visual field. Despite traditional paper-and-pencil neuropsychological tests are considered the standard approach for neglect diagnosis, they often lack sensitivity, specificity, and accuracy, particularly in detecting mild or uncommon forms of neglect. Some studies detected alterations in visual search patterns that might constitute a typical visual search profile for neglect. The aims of the review were to synthesize the literature currently available about the evaluation of visual search alterations in neglect using technological devices and detecting alterations in eye movements that might help in making neglect diagnosis more reliable. A systematic search on PubMed database was carried out for studies published between 2015 and 2025 investigating eye-movements in neglect, with ten studies meeting the inclusion criteria. The review confirmed the existence of a distinctive visual search profile in neglect patients. Key findings include significantly reduced saccade amplitudes, a constricted field of exploration and an increased angular velocity toward the right. Furthermore, a consistent rightward shift in the spatial distribution of visual fixations was observed across the literature. These parameters provide a more objective understanding of the behavioral manifestations of neglect than paper-and-pencil tests, therefore the adoption of these instruments should be further systematized and integrated into clinical practice. Future research should also prioritize the further definition and validation of this abnormal visual search profile to establish its efficacy as a clinical biomarker of neglect.