This video shows an eye suffering from superior oblique myokymia. This occurs when the superior oblique muscle rhythmically fires, causing a twitching intorsion of the eye. This is a difficult finding to pick up by simple external examination alone, as the twitching is subtle. Under the microscope, however, you can see the eye intorting. The key is to examine the conjunctival vessels as they move rhythmically.
These patients present with a lot of discomfort from oscillopsia and treatment is challenging in my experience. Typically involves medical therapy as surgery isn’t terribly helpful and can cause significant diplopia afterwards.
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superiorobliquemyokymia.wmv (2.4 meg, Windows video file)