الفهرس 
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Abstract
The present study included 556 patients suffering squint. They were 206 males, and 351 females from all ages, attending the out patient clinic of strabismus at ophthalmology center, Mansoura University for a period of nine months. Material and Methods:Each of the included patients was systematically subjected for both ophthalmologic and strabismologic examination to elicit vertical deviation among all. The examination included the following items in about order: History, Slit lamp and fundus examination, Visual acuity, Refraction, The monocular cover-uncover test, The Bruckner’s test, Hirschberg’s method, The simultaneous prism-cover test, Diagnostic positions of gaze, The Maddox rod test, The double Maddox rod test, The Maddox wing test, The three step test, Old family photographs, Major amblyoscope testing, Active force generation test, The forced duction test, Hess screen, Diplopia charts, Radiological examinations, and Laboratory investigations. Results: • Vertical deviation represents more than 25% of squint cases. • Duane syndrome, third nerve palsy, and inferior oblique muscle overaction, are the bulk of cases encountered with vertical deviation, and count for more than 15% of all cases of squint. • Females represented more than two-thirds of cases of Duane syndrome and Graves disease, while men represented about two-thirds of 3rd nerve palsy. • Horizontal association with 69%of vertical cases. • Forced duction test was positive to all cases of Brown syndrome for the superior oblique muscle, and for number of cases of Graves disease for different muscles, while negative to most of cases of Duane syndrome. Conclusions: • Vertical deviation is common. • Full clinical ophthalmologic, and srabismologic examinations, and investigations are sufficient to diagnose a longstanding, and established case of vertical squint. • Forced duction test, forced muscle generation test, and Hess screen test can give variant data concerning one case that some variations in the intensity and degree of motility imbalance can be noticed, but all would point for the same nature, type of deviation, and diagnosis. • Iatrogenic, refractive, and acquired cases, beside head positions, and inaccurate history can be misleading. Old family photographs would be helpful in such conditions. • Cycloductios on slit-lamp, and ophthalmoscope are complementary to the nine diagnostic positions of gaze, especially in cases of vertical deviation, and should be marked, and added to registering charts.