Thyroid-related orbitopathy is a form of orbital inflammation associated with thyroid dysfunction, developing in many patients with Graves disease. Fibrosis of the inferior rectus muscle can lead to restricted elevation and vertical ocular misalignment, which may be improved by recessing this muscle. In some patients, vertical misalignment persists after surgical weakening of one or more vertical rectus muscles. In this case series, unilateral inferior oblique recession as a secondary procedure after inferior rectus recession reduced hypertropia in primary gaze from 9(Delta) +/- 3(Delta) to 1.3(Delta) +/- 1.5(Delta) (mean +/- standard deviation) and largest hypertropia in side gaze from 18.3 +/- 2.1(Delta) to 3.3(Delta) 1.5(Delta). Postoperatively, all 3 patients were diplopia free in primary and downgaze.
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