title: The four-step test for diagnosis of paralytic and/or restrictive strabismus.
abstract: By placing four diagnostic steps in a logical sequential manner, the diagnosis of a paralytic or restrictive deviation is made somewhat easier. Each time an incomitant strabismus is presented to an ophthalmologist, the four-step procedure should be used. Versions, ductions, and the cover test will reveal the eye to be investigated. Saccades, forced ductions, and/or forced generations will determine the problem and direct a surgical approach if needed.
mesh_terms: D004370:Duane Retraction Syndrome / Q000175:diagnosis; D005133:Eye Movements; D006801:Humans; D012438:Saccades; D013285:Strabismus / Q000175:diagnosis*