Superior oblique tendon recession of 12 to 14 mm was performed in five patients with inferior oblique muscle palsy and three patients with Brown's syndrome. The angle of deviation was decreased by an average of 18 prism dioptres in the worst field of gaze for the former group and by 17.3 delta for the latter group. As a secondary benefit of the procedure for the patients with inferior oblique palsy, any associated preoperative A-pattern was collapsed an average of 10 delta postoperatively. The procedure eliminated all abnormal head postures and improved versions and ductions for both groups. Symptoms of diplopia and torsion were resolved, and full fusional ability was maintained at preoperative levels in all fields of gaze for all patients. After an average follow-up period of 18 months none of the patients had manifested superior oblique palsy or other notable postoperative surgical complications. Theoretical advantages of superior oblique tendon recession include the potential for reversibility and reoperation if required, the possibility of asymmetric surgery and the potential to perform the procedure with an adjustable suture. The technique is an advantageous approach in the surgical treatment of these complicated cases.