To compare the surgical outcomes of recession-resection (R&R) on the contralateral eye and medial rectus re-resection surgery for recurrent intermittent exotropia in patients who previously underwent unilateral recess-resection.

A retrospective analysis was performed on patients who underwent either R&R on the contralateral eye or medial rectus re-resection surgery for recurrent intermittent exotropia who had unilateral R&R previously with a minimum follow-up period of at least 12 months.

Thirty-nine patients underwent contralateral R&R surgery and 13 patients underwent medial rectus re-resection surgery. The satisfactory surgical result was considered between -5 (prism diopters, PD) and +10PD. The success rate of the contralateral R&R group and medial rectus re-resection group was 84.6% and 100% ( p =0.317) at postoperative 1 week, 79.5% and 46.2% ( p =0.034) at postoperative 6 months, 69.2% and 38.5% ( p =0.048) at postoperative 12 months, and 51.3% and 7.7% ( p =0.006) at the last follow-up visit.

The long-term surgical outcome of R&R surgery on the contralateral eye for the patients with recurrent intermittent exotropia who previously underwent unilateral R&R surgery was significantly better than medial rectus re-resection.