A new rationale for the management of large angle esotropia.

It is not only possible but safe to exceed the traditional 5 mm maximum recession of each medial rectus muscle to correct large angle esotropia. It is possible to grade the amount of recession to the preoperative deviation, similar to that which is done for esotropia less than 35 prism diopters. The results of this series indicate that alignment to within 10 prism diopters with one procedure is more likely by large recessions of the medial rectus than by other approaches. If a reoperation is necessary, there still remain two other untouched horizontal muscles on which to operate.