• Vertical Strabismus refers to a vertical misalignment of the visual axes of the two eyes in the vertical direction in any of the nine cardinal positions of gaze.
  • Vertical Strabismus is more symptomatic than horizontal Strabismus.
  • Usually, the vertical recti or the oblique muscles are involved.
  • This could be Comitant (Deviation that is the same magnitude regardless of gaze position) or Incomitant (it’s magnitude varies as the patient shifts his or her gaze).
  • Associated with horizontal deviation.
  •  Types are—

▪︎Hypertropia:– non Fixating eye is higher than Fixating eye.

▪︎Hypotropia:– Fixating eye is higher than non Fixating eye.


  1. Depending upon the constancy of deviation hyperphoria
  • Intermittent Hypertropia
    • Hypertropia
  • The direction of deviation in the non Fixing eye
  • Hypertropia
    • Hypotropia
  • Depending upon the competence of deviation
  1. Comitant vertical deviation
  • Refractive (induced)
    • End result of long-standing Paralytic deviation
  • Incomitant vertical deviation
  • Apparent oblique muscle dysfunction interior oblique overaction Inferior oblique Underaction Superior oblique overaction Superior oblique Underaction
  • Paretic vertical deviation Congenital unilateral Superior oblique paresis-congenital Superior oblique paresisBilateral Superior oblique paresisMonocular Elevation deficiency Monocular depression deficiency Superior rectus paresis Inferior rectus paresis Skew deviation
  • Restrictive vertical deviation-
  1. Vertical deviations in Duane’s retraction syndrome. Brown’s syndrome Congenital muscle fibrosis Dysthyroid orbitomyopathy.Post-traumatic orbital wall fractures.Tumors, pseudotumors, and cysts in the orbit.
  • Dissociated vertical deviation (DVD)
  • Monocular DVD
    • Binocular or alternating DVD


  • Convertion of Incomitant Paralytic hyperdeviation.
  •  Ocular muscle weakness  
  • Central ocular control disturbances
  • Underaction of extraocular muscles.
  • Secondary to hemorrhage or mechanical trauma with extraocular muscle atrophy.
  • Traumatic neuroparesis.
  • Secondary fibrosis of the extraocular muscles.
  • Unequal refractive correction.



Common signs include —

  • Ocular deviation in the vertical direction in any of the nine cardinal positions of gaze position of gaze with either eye fixing on the Hirschberg test and prism cover test.
  • Ocular motility tests can show the limitation of movements in the vertical direction.


  • Commonly Intermittent than constant.
  • Suppression
  • Vertical Diplopia
  • Amblyopia
  • Vertical anomalous retinal correspondence
  • Vertical deviation of the eye.
  • Abnormal head posture – Tilting of head and chin up or down.
  • Repeated measurement shows the overaction of one or more cyclovertical muscle.


  1. Orthotics:—
  2. to eliminate suppression may be indicated prior to surgery.
  3. It is impossible to improve Vertical fusional vergence through Orthotic training.
  • Prismotherapy:—
  • Smaller than 11D can correct prism

              Hypertropia = 5pd BD

              Hypotropia = 5pd BO

  • Surgical correction

Ruksar Warsi

#Optometrist 👁♥️ #Optimistic 👩‍⚕️ #Eye and vision care professional👁

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