Strabismus is a common problem encountered by eye and vision care professionals and alternating exotropia is a common diagnosis of patients with strabismus. When measuring the deviation it is often easier to elicit consistent near fixation than at distance, particularly with children and special populations. The purpose of this study was to investigate the existence of a correlation between far gaze measurements with 10o or 25o of upward gaze at near with alternating exotropia. The sample was a cross-sectional pilot study of 41 patients with a definite diagnosis of basic alternating exotropia, either intermittent or constant. The deviation was first measured at far gaze and then in an up gaze position with neck flexion of 10o and 25o, respectively. The outcome measures were correlations between exotropia measurements in far gaze and both the 10o and 25o upward near gaze measures. Measuring exotropia in upward gaze instead of far gaze offers the possibility of a more reliable method of measurement with children and noncooperative patients.