We evaluated the efficacy of eye muscle surgery in 4 patients with ocular myasthenia gravis with troublesome diplopia. All patients were in remission and had shown a consistently stable angle of deviation for at least 6 months preoperatively. The extent of eye muscle surgery was based on the degree of deviation in the primary position, and conventional recession and resection procedures were performed in 3 patients and hang-loose recession with an adjustable recession in 1. Single binocular vision was obtained in 3 patients in the primary position without prism correction or compensatory head posture. Electron-microscopic studies on the eye muscle specimens obtained at strabismus surgery revealed non-specific degenerative findings for the muscle fibers and sarcomeric disorganization compared to that in a control extraocular muscle.