Physical examination maneuver

Physical Exam

Alternate Cover Test (Test of Skew)

also known as Cross-cover test
🎬
Video coming September 2026

How to Perform

Ask the patient to fixate on a target. Cover one eye, then move the occluder across to the other eye, and repeat back and forth, pausing briefly on each eye; watch the just-uncovered eye for any movement to take up fixation. A refixation movement indicates an ocular deviation.

How to Interpret

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References

  • Gottlieb M, Peksa GD, Carlson JN. Head impulse, nystagmus, and test of skew examination for diagnosing central causes of acute vestibular syndrome. Cochrane Database Syst Rev. 2023 Nov 2;11(11):CD015089. doi:10.1002/14651858.CD015089.pub2. PMID 37916744. PMC10620998. Cochrane diagnostic-test-accuracy review; bivariate pooling; composite estimate from the 8-study advanced-imaging-reference subgroup (n=1146); test of skew separately pooled across 10 studies (n=1313).
  • McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

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