What is the role of the upright-supine test in the evaluation of trochlear nerve palsy (fourth nerve palsy)?

Updated: Oct 08, 2019
  • Author: Zafar A Sheik, MD, MD; Chief Editor: Andrew G Lee, MD  more...
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The upright-supine test can differentiate skew deviation from other causes of vertical strabismus. Measure the patient’s vertical misalignment while in the upright position. Then, measure again while the patient is supine. A decrease of more than 50% in supine is a positive result. The vertical misalignment caused by skew deviation depends on head position, whereas it would not change in trochlear nerve palsy. Based on a study by Wong et al, this test has 76% sensitivity and 100% specificity. [27]

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