OBJECTIVE To study the surgical effects of bilateral graded inferior oblique muscle (IO) recession on the reduction of the V pattern deviation and severity of inferior oblique muscle overaction (IOOA) in children who had bilateral superior oblique muscle palsies (SOP) with secondary inferior oblique muscle overaction. METHODS Seven patients who presented with bilateral SOP with secondary IOOA were included. All patients had V pattern deviation and bilateral graded IO recession was done. The data of age, sex, deviation in primary position, V pattern and severity of IOOA was recorded both pre- and post -operatively. The comparison of pre-operative and post-operative amount of V pattern and IOOA was analyzed with nonparametric statistical analysis. RESULTS Four females and three males had the average age of 5.7 +/- 1.8 years old. The mean pre-operative severity of IOOA was + 3 and the mean pre-operative deviation of the V pattern was 36 +/- 11.4 prism diopters (PD). The mean post-operative severity of IOOA was + 0.4 and of V pattern deviation was 10.7 +/- 4.4 PD. Comparing the pre-operative and post-operative severity of lOOA and V pattern deviation by non-parametric statistical analysis and the result was statistically significant. CONCLUSIONS Bilateral graded IO recession is an effective surgical procedure to reduce the V pattern and the severity of IOOA in the children who are suffering from bilateral SOP with secondary IOOA.