Three cases are presented of congenital inferior rectus (IR) dysgenesis causing hypertropia. Case 1 was a two-year-old female with intermittent vertical strabismus of 20PD and -2 limitation on depression, worse in abduction. MRI imaging showed a hypoplastic IR. Following surgery, the deviation improved to 4PD with improved ocular motility and no abnormal head posture. Case 2 was a 21-year-old male with constant non-progressive vertical deviation from birth measuring 40PD vertical and 20PD esotropia. Following surgery, the deviation improved to 10PD esotropia with better ocular motility. Case 3 was a 29-year-old female with constant vertical and exotropia since childhood, measuring 45PD hyper and 20PD exo. This reduced postoperatively to 10PD exo and 6PD vertical with improved ocular motility. There was no other ocular, cranial or systemic anomalies for these three cases. Surgery for all three cases involved superior rectus weakening with or without inferior oblique anteriorisation. The authors discuss common signs including hypertropia, A strabismus pattern, AHP, diplopia and limitations of ocular motility. Orbital imaging aids diagnosis. There appears to be a female preponderance but no single preferred surgical method as evident from a literature search. They recommend surgery be tailored to individual cases.