| Supranuclear causes | | Supranuclear monocular elevation paresis (congenital or acquired) | | Skew deviation | | Vertical one-and-a-half syndrome | | Wernicke's syndrome | | Paroxysmal superior rectus and levator palpebrae spasm with multiple sclerosis | | Ocular motor nerve dysfunction | | Third cranial nerve palsy | | Fourth cranial nerve palsy | | Superior oblique myokymia | | Ocular neuromyotonia | | Ophthalmoplegic migraine | | Wernicke's syndrome | | Fisher's syndrome | | Guillain-Barré syndrome | | Sixth cranial nerve palsy | | Decompensation of a long-standing phoria | | Neuromuscular junction disease | | Myasthenia gravis | | Botulism | | Diseases of eye muscle | | Isolated paresis of a vertical-acting extraocular muscle, superior oblique, inferior oblique, superior rectus, or inferior rectus (for example, due to congenital causes, myasthenia gravis, Graves' disease, botulism, trauma, postoperative sequelae, trochleitis, orbital metastasis, orbital pseudotumor, and muscle ischemia resulting from giant cell arteritis) | | Decompensation of a long-standing phoria | | Graves' disease | | Chronic progressive external ophthalmoplegia syndromes | | Postsurgical (eg, cataract operation) | | Congenital strabismus syndromes | | Dissociated vertical deviation | | Congenital "double elevator" palsy (monocular elevation deficiency) | | Double depressor paralysis (unilateral paralysis of the inferior rectus and superior oblique) (congenital or acquired) | | Physiologic hyperdeviation on lateral gaze (asymptomatic) | | | Mechanical processes causing vertical eye misalignment | | Graves' disease | | Brown's superior oblique tendon sheath syndrome | | Congenital | | Acquired (for example, due to superomedial orbital trauma, tenosynovitis or myositis, adhesions, metastasis to the superior oblique muscle, frontal sinus osteoma, pansinusitis, peribulbar anesthesia, blepharoplasty, maxillofacial or sinus surgery, and superior oblique tuck) | | Acquired Brown's syndrome associated with underaction of the ipsilateral superior oblique muscle ("canine tooth syndrome") | | Orbital floor blow-out fracture | | Direct trauma to the extraocular muscles (for example, intramuscular hematoma) | | Congenital inferior rectus fibrosis | | Strabismus fixus (generalized fibrosis of extraocular muscles) | | Postoperative sequelae (including retinal detachment surgery, orbital surgery, strabismus surgery, and cataract surgery) | | Orbital inflammation (myositis) and pseudotumor | | Metastatic infiltration of extraocular muscles | | Orbital tumors Fallen eye syndrome (patient with long-standing superior oblique muscle paresis who habitually fixates with the paretic eye may have development of hypodeviation of the uninvolved eye caused by contracture of the contralateral inferior rectus muscle) | | Rising eye syndrome (long-standing inferior oblique muscle palsy may result in contracture and fibrosis of the contralateral superior rectus muscle) | | Hemifield slip, retinal disease, and fictitious diplopia | | Hemifield slip phenomenon resulting from dense bitemporal hemianopsia or heteronymous altitudinal field defects | | Foveal displacement syndrome (eg, due to subretinal or preretinalneovascular membranes) | | Fictitious (nonorganic) vertical diplopia | |
