The evaluation of cases operated for vertical deviation. Materials and Methods: Cases operated between January 2015 and June 2016 and followed-up for at least 1 year were evaluated. Pre and postoperative angle of deviations (PD), inferior oblique muscle (IO) functions, refractive errors, etiologies and surgeries performed were noted. Success was defined as alignment with 10 PD of orthophoria and/or inferior oblique overaction (IOOA) ≤+1 at the final examination. 32 out of 172 cases, surgery due to vertical deviation was performed. Primary IOOA cases (group 1; n=19; 15 was associated with esotropia, 4 with exotropia) were compared with cases (group 2; n=13) due to other etiologies [3 Duane retraction syndrome (DRS) type 3, 4 fourth nerve palsy, 4 dissociated vertical deviation (DVD), and double elevator palsy (DEP)]. IO recession was performed in all primary IOOA and fourth nerve palsy. Y-split and lateral rectus recession was performed in DRS, superior rectus recession in DVD, and inferior rectus recession in DEP. Right spherical equivalent (SE) (D) was 1.5 (0.75-2.5) in group 1 and 0.5 (-0.625-0.875) in group 2 (p=0.014). Left SE (D) was 1.5 (0.75-2.5) in group 1 and 0.5 (0.125-1) in group 2 (p=0.024). IOOA decreased from 3.16±0.60 to 0.89±0.81 postoperatively in group 1 cases (p<0.01). The upshoot regressed in 3 DRS type 3 cases postoperatively. Successful outcome was obtained in 16 cases in group 1 (84%) and 11 cases in group 2 (84%). Satisfactory outcome is possible by case-by-case approach in various vertical deviations.