Patients with vertical motility dysfunction complain of vertical or torsional diplopia. It helps to quickly differentiate the motility disorders by simply asking the patient whether he or she sees double side by side or up and down, or ‘Show me with your hands’, ‘Does it get worse (or better) when you look to the left or right?’, ‘Does it get worse (or better) when you tilt your head right or left)?’, ‘Does the double vision go away when you cover one eye?’ If the latter is the case then this indicates a bona fide neuro-ophthalmologic/orbital problem. If it is not, the patient has uniocular diplopia (ghosting) and the etiology is almost always refractiveopacities in the cornea or lens-necessitating a careful dilated ocular examination to make the diagnosis (see Chapter 2).