The purpose of this retrospective study was to analyse the surgical effect / success rate of recession of the medial rectus in 90 patients with horizontal diplopia. Mean age was 52.5 ±9.4 years. Of that 24% had unilateral medial rectus recession and 76% had bilateral recessions. Mean recession was 3.3 (2-5mm) for unilateral recession and 4.5 (2.7-7mm) for bilateral. Preoperative angle of deviation was not influenced by muscle volume or decompression approach. Dose response was 1.0 (-0.6 to 3.8) degrees/mm for unilateral recession and 1.4 (0.2 to 3) degrees/mm for bilateral. Overall approximately 80% required one operation only to resolve horizontal diplopia.