A 21-year-old female presented with symptoms of ocular vertical misalignment, vertical diplopia and abnormal head posture that began just after her last test six months ago. Symptoms were initially intermittent, but had become more frequent in the previous month. 

In primary position, the vertical diplopia was fully alleviated by lifting her chin. She also reported greater ocular discomfort in the left eye and a dull frontal headache since the onset of symptoms. 

She is currently taking Lucette and leflumonide 20mg once daily for rheumatoid arthritis. No other ocular or systemic symptoms were reported, and no relevant previous ocular or family history.