A clinical evaluation of a 35-year-old man with episodic vertical diplopia and oscillopsia is discussed. A diagnosis of superior oblique myokymia, a relatively rare and frequently undiagnosed neuromuscular syndrome is made. Considerable medical research suggests that this is a motor neuron disturbance related to regeneration following injury or inflammation of the trochlear nerve. This report discusses control of one patient's symptoms of monocular image fluttering with prism lenses. Various medical approaches including surgery have been found to have limited success and involve a high risk due to many contraindications.