Background: Strabismus in thyroid ophthalmopathy is based on a loss of the con tractility and distensibility of the external ocular muscles. Different therapeu tic approaches are available, such as recession after pre-or intraoperative mea surement, adjustable sutures, antagonist resection, or contralateral Synergist f adenoperation. Patients and Methods: 26 patients with strabismus in thyroid opht halmopathy were operated between 2000 and 2003. All patients were examined preop eratively, then 1 day and 3-6 months (maximum 36 months) postoperatively. Befor e proceeding with surgery, we waited at least 6 months after stabilization of oc ular alignment and normalization of thyroid chemistry. Results: Preoperative ver tical deviation was 10 -44 PD (mean 22), 3 months postoperatively it was-2-10 PD (mean 1.5). Recession of the fibrotic muscle leads to reproducible results: 3.98 ±0.52 PD vertical deviation/mm for the inferior rectus. In the case of a l arge preoperative deviation a correction should be expected, which might not be sufficient in the first few days or weeks; a second operation should not be carr ied out before 3 months. 7 patients were operated twice, 1 patient need three op erations. 4 patients (preop. 0) achieved no double vision at all; 15 patients (preop. 1) had no double vision in the primary and reading positions; 3 patients (preop. 0) had no double vision with a maximum of 5 PD; 1 patient (preop. 7) had double vision in the primary o r reading position even with prisms; and 2 patients (preop. 17) had double visio n in every position. Conclusions: We advocate that recession of the restricted i nferior or internal rectus muscle is precise, safe and effective in patients wit h thyroid ophthalmopathy. The recessed muscle should be fixed directly at the sc iera to avoid late overcorrection through a slipped muscle. The success rate in terms of binocular single vision was 76%and 88%with prisms added. Background: Strabismus in thyroid ophthalmopathy is based on a loss of the con tractility and distensibility of the external ocular muscles. Different therapeu tic approaches are available, such as recession after pre-or intraoperative mea surement, adjustable sutures, antagonist resection, or contralateral Synergist f adenoperation. Patients and Methods: 26 patients with strabismus in thyroid opht halmopathy were operated between 2000 and 2003. All patients were examined preop eratively, then 1 day and 3-6 months (maximum 36 months) postoperatively. Befor e proceeding with surgery, we waited at least 6 months after stabilization of ocular alignment and normalization of thyroid chemistry. Results: Preoperative ver tical deviation was 10 -44 PD (mean 22), 3 months postoperatively it was-2-10 PD (mean 1.5). Recession of the fibrotic muscle leads to reproducible results: 3.98 ± 0.52 PD vertical deviation / mm for the inferior rectus. In the case of al arge preoperative deviation a correct ion should be expected, which might not be sufficient in the first few days or weeks; a second operation should not be carried out before before 3 months. 7 patients were operated twice, 1 patient need three op erations. 4 patients (preop. 0 3 patients (preop. 0) had no double vision with a maximum of 5 PD; 1 patient (preop. 1) had no double vision in the primary and reading positions; ) had double vision in the primary or reading position even with prisms; and 2 patients (preop. 17) had double visio n in every position. Conclusions: We advocate that recession of the restricted i nferior or internal rectus muscle is precise, safe and The successful rate in terms of binocular single vision was 76% and 88% with prisms added.