Aim To evaluate long-term surgical outcomes and risk factors for recurrence after unilateral lateral rectus muscle recession (ULR) in children with small to moderate angle intermittent exotropia (IXT).

Methods 214 patients with basic type IXT of 15–24 prism dioptres (PD) who underwent ULR were included. The main outcome measure was success rate at 2 years after surgery and at final follow-up. The risk factors related to recurrence were evaluated using univariable and multivariable logistic regression analyses.

Results Success rate at postoperative 2 years was 92.5% and at final examination after a mean follow-up of 3.9 years was 83.2%. No overcorrection was observed. Preoperative exodeviation of 20–24 PD was the significant risk factor for recurrence according to both univariable (OR=3.577, p=0.022) and multivariable analysis (OR=3.265, p=0.034).

Conclusions The overall long-term successful alignment rate of ULR for 15–24 PD of IXT was good. However, patients with 20–24 PD of IXT showed worse prognosis compared with 15–19 PD of IXT.