To investigate and compare the clinical courses and surgical success rates of secondary operations in recurrent exotropia according to the type of first operation for correction of exotropia.

A retrospective chart review was performed for all patients with recurrent exotropia of the basic or pseudodivergence excess types. In group A (36 patients), bilateral lateral rectus (LR) recession was performed as the first operation and uni- or bilateral medial rectus (MR) resection was performed as the second operation. In group B (19 patients), unilateral LR recession-MR resection (R&R) was performed as the first operation and LR recession or R&R in contralateral eye as the second operation.

There were no significant differences between the 2 groups when considering age at each operation, frequency of the amblyopia, prescription of prism, time interval for recurrence and reoperation and the final and cumulative success rates. No postoperative complications were observed in either group. The mean number of used muscles for the first and second operation was 3.9 ± 0.4 in group A, and 3.4 ± 0.5 in group B ( p = 0.001). Mean time interval for occurrence of postoperative orthophoria was 3.7 ± 6.2 months in group A and 6.5 ± 16.2 in group B ( p = 0.047). In group B, the incidence of esodeviation tended to increase after postoperative 1 month.

The final success rates of reoperation between the 2 types of the first operation in recurrent exotropia were similar. Mean time between postoperative overcorrection of orthophoria was shorter in the group with bilateral LR recession followed by secondary MR resection than in the other group. Unilateral R&R followed by LR recession or R&R in contralateral eye may be more helpful to decrease the number of used muscles than in the bilateral LR recession followed by secondary MR resection.