The head tilt test assays superior oblique paresis by exploiting the differing effects of each vertical muscle on torsion and elevation.
A positive result occurs when, on tilting the head to the affected side, the paralytic eye moves upwards in the palpebral fissure. Both muscles that attach to the top of the eyes contract to intort the eye and maintain the position of the retinal vertical meridian as far as possible. A weakness in the superior oblique results in an imbalance of vertical forces, so that hypertropia is worsened.
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