The purpose of this study was to determine the incidence of horizontal strabismus needing surgical management in Brown’s syndrome. This was a retrospective review of 19 eyes (eight right and 11 left) of 16 patients (seven male and nine female). Mean age at surgery was 4.2±2.6 years with a median follow-up of nine months. Fourteen patients had surgery for abnormal head posture and two had surgery for primary hypotropia. Nine had a primary horizontal deviation; eight exo. Mean preoperative angle was 9.3±3.4PD reducing to 1.7±1PD postoperatively. Abnormal head posture reduced in all cases. The authors found 50% of patients had significant horizontal strabismus which required surgery.