This patient presented with intermittent monocular (right eye only) vertical and torsional oscillopsia. Note the frequent torsional, with slight vertical movements of the right eye, lacking a regular pattern. Occasionally, patients may demonstrate a vertical misalignment during the attacks, due to over- or underaction of the affected superior oblique. These monocular, involuntary movements can be well observed at the slit lamp under magnification. Observing a conjunctival landmark such as a radially oriented vessel, or as in this case, a pingueclum, can also be helpful.