Background To compare outcomes following contralateral lateral rectus (LR) recession and recess–resect (RR) procedures for recurrent exotropia of 20–25 prism dioptres (PD) after unilateral RR.

Methods 39 subjects were included in this retrospective study. All underwent, as a primary surgery for intermittent exotropia, unilateral RR on the non-dominant eye. They were assigned to the subsequent contralateral LR recession (LR, n=19) or RR (n=20) group for recurrent exotropia of 20–25 PD. Surgical success was defined as alignment between 5 PD esodeviation and 10 PD exodeviation.

Results The mean follow-up duration after the reoperation was 32.3±26.4 months in the LR group and 30.5±26.8 in the RR group (p=0.945). The mean deviation angles at postoperative 1 day were −0.7 PD (overcorrection) in the LR group and −4.3 PD in the RR group (p=0.047). The deviation angles at 3 and 6 months postoperatively were not significant (p=0.771, p=0.923). The final successful outcome was achieved in 63.2% of patients in the LR group and in 65% of patients in the RR group (p=0.905).

Conclusions Contralateral LR recession was found to be a safe and effective procedure for the treatment of recurrent exotropia of 20–25 PD after unilateral RR for intermittent exotropia. With LR recession, the intentional overcorrection in the immediate postoperative period could be avoided.