Purpose <p>3D exoscopes have been increasingly adopted in otorhinolaryngology. However, conventional passive-polarized 3D displays (PPD) have limitations in vertical viewing angle, which can impair 3D visualization at nonfrontal angles, particularly for surgical assistants. Active-polarized 3D displays (APD) can overcome these limitations. This study aimed to compare the usability and performance of a conventional PPD and a prototype APD using the ORBEYE 4&#xa0;K 3D exoscope system under viewing conditions unfavorable to the PPD.</p> Methods <p>Twenty-four otorhinolaryngologists participated in the study. A prototype APD and a commercially available PPD were connected in parallel to the ORBEYE. The participants performed a procedural task simulating stapes surgery with the viewing position set 20° above the display center. The task performance was evaluated based on the number of successfully completed procedural tasks. A target-tracking test was performed before and after the procedural task to evaluate ocular fatigue by calculating the slope of the saccadic main sequence. The usability was assessed using a questionnaire.</p> Results <p>The APD scored higher than the PPD for all questionnaire items. The number of successful procedural tasks was significantly higher in the APD group. With the APD, there was no change in perceived ocular fatigue before and after the procedural task, whereas with the PPD, there was a tendency toward increased fatigue.</p> Conclusion <p>The APD demonstrated superior usability and task performance compared to a conventional PPD, particularly under vertically displaced viewing conditions. APD may be particularly beneficial for assistants and surgeons working at various levels of the eye.</p>