Past experience with weakening the superior oblique muscle by tenotomy has been complicated by unpredictable results. Superior oblique recession has been advocated as a more controlled and reliable procedure. We retrospectively studied 20 cases of superior oblique tendon recession and tenotomy from the Bascom Palmer Eye Institute over the last ten years. All cases were compared with respect to the amount of deviation corrected, ability to eliminate "A" pattern strabismus, preservation of muscle function, and complications. Both procedures were equally effective in eliminating "A" pattern strabismus regardless of the initial size of the pattern. Unilateral superior oblique recessions were less erratic than tenotomies but tended to result in a slight undercorrection. The complications were similiar for each procedure. We could not demonstrate a clear advantage of bilateral superior oblique recession over tenotomy. Unilateral recession needs further investigation and may have prove useful when combined with the adjustable suture technique.