The aim of this study was to review the surgical outcomes of the Fells modified Harado-Ito procedure using a dose scale approach with long-term follow-up, and to evaluate the relationship between preoperative factors and final outcome. This was a retrospective review of 27 patients with mean age of 57.6 years (range 22-81) and 17 being male. Unilateral surgery was undertaken for 21 and bilateral for six. Isolated fourth nerve palsy was present for 26 and one with combined fourth and third nerve palsy. All had the modified procedure and three had added horizontal and vertical surgery combined. Mean postoperative follow-up was 25 months (range 3-89). Overall, preoperative mean extorsion measured by Maddox rod was -10.4 degrees (0 to 30) reducing to -2.7 degrees (-10 to 0) at follow-up. Mean torsional correction was 7.7 degrees (95% CI 6.27: 9.21) with significant change. There was a strong positive correlation for pre to post measurements with larger deviation having a greater change. For unilateral cases mean extorsion reduced from -9.8 to -2.8 degrees (change of 7 degrees). For the bilateral case, mean extorsion reduced from -13.7 to -5.4 degrees (change of 8.3 degrees). Twenty-five patients regained cyclofusion (93% success rate). There were no post-surgical complications. It was not possible to develop a standardised dose scale according to the amount of cyclo deviation present. The same surgery for the same angle yielded different results for different patients. Final outcomes were influenced by preoperative individual assessment including measurement of cyclofusional capacity.