To investigate whether combining inferior oblique weakening procedures with bilateral lateral rectus recession as a surgical approach to intermittent exotropia enhances postoperative horizontal angle of deviation over bilateral lateral rectus recession alone.

Patients were allocated to one of two surgical groups: a bilateral lateral rectus recession group (Group 1) or a bilateral lateral rectus recession with bilateral inferior oblique weakening group (Group 2). Group differences in the angle of distance deviation were evaluated preoperatively and at 3- and 12-months postoperatively.

There were no significant differences in preoperative factors or angles of deviation between Group 1 (n = 98) and Group 2 (n = 77); no significant intergroup difference in the angle of deviation was observed at any postoperative time point ( p > 0.05).

Combined inferior oblique weakening procedures did not significantly influence the horizontal angle of deviation after surgery for intermittent exotropia. Accordingly, there is no need to revise the surgical amount of lateral rectus recession.