Physical Examination – Skew Gaze (Test of Skew)

The Skew Gaze Test, also known as the Test of Skew, is an important bedside eye alignment examination used in patients with acute vertigo, dizziness, imbalance, and suspected central vestibular disorders. It is a key part of the HINTS examination (Head Impulse, Nystagmus, Test of Skew) and helps specialists identify whether dizziness may be caused by a brainstem or cerebellar problem such as stroke, rather than a simple inner ear disorder.

At our audiology and vertigo clinic, this test is performed by trained specialists during a complete vestibular and neurological bedside assessment. It is especially useful for patients with sudden continuous vertigo, walking imbalance, nausea, vomiting, and spontaneous nystagmus.

How the Test Works

During the examination, the patient is asked to look at the examiner’s nose or a fixed target. The specialist then covers one eye and quickly uncovers it, repeating the same on both sides.

The doctor carefully watches for any vertical corrective eye movement when the eye is uncovered:

  • Normal test: no vertical eye movement
  • Positive skew: the eye moves upward or downward to re-align

A positive skew deviation suggests central nervous system involvement, often affecting the brainstem or cerebellum. The test is safe, quick, painless, and usually completed within 2–5 minutes.

Benefits of Skew Gaze Test

  • Quick bedside stroke screening
  • Detects central vestibular pathology
  • Helps differentiate ear vs brain causes of vertigo
  • Non-invasive and painless
  • Useful in emergency dizziness evaluation
  • Supports HINTS exam accuracy
  • Immediate treatment decision support

FAQ – Skew Gaze Test

It is a cover–uncover eye test used to check vertical eye misalignment in patients with vertigo and suspected stroke.

No, the test is completely safe, painless, and non-invasive.

The test usually takes 2 to 5 minutes.

A positive result means there is vertical eye correction movement, which may suggest a brainstem or cerebellar cause of dizziness, including stroke.

Yes, it is the “TS – Test of Skew” component of the HINTS bedside examination.