This study sought to detect abnormal scleral attachment with comparison of histopathological findings in consecutive exotropia. The study also considered the success rate of medial rectus resection and advancement, dose response and evaluate potential preoperative factors that might indicate presence of abnormal scleral attachment. The study included 30 eyes of 30 patients. Preoperative angle was 37.3±13.6PD at near and 34.6±12.2PD at distance. At six months postoperatively changes in deviation from baseline were 30±10.5PD at near and 33.3±13.5PD at distance. Twelve cases (40%) showed abnormal scleral attachment. Mean medial rectus resection was 4.15±0.44mm and mean medial rectus advancement was 3.42±1.6mm. There was a significant correlation between preoperative adduction limitation and scar percentage in pathology. At six months, 63% had surgical success of <10PD at near and distance. Mean dose response was 4.7PD for near and 4.2PD for distance per mm. The authors conclude that addition of lateral rectus recession or use of nonabsorbable sutures might improve the success rate.