This is a retrospective review of infants requiring surgery for infantile exotropia before the age of one year to report the surgical outcomes and frequency of associated developmental problems. The study reviewed 26 patients first assessed at two to 10 months of age. Exotropia was 20-95PD – mean 40.58PD. Age at surgery ranged from four to 18 months (mean 9.25 months) and surgery involved bilateral lateral rectus muscle recessions of mean 7.8mm. Four patients also had inferior / superior oblique muscle recession and three had lateral rectus transposition for pattern strabismus. Two patients had botulinum toxin injection into the lateral rectus muscle. Intermittent exotropia was present in 18 patients and constant exotropia in eight. Fifty percent had amblyopia treatment. After the first procedure, there was a 38% success rate. Sixteen patients required reoperation (ten residual exotropia and six consecutive esotropia) with 50% success rate. Three patients required reoperation of three or more procedures. Follow-up was from one to 16 years (mean seven years). Of all cases, 38% had developmental delay. The authors conclude that infants with early exotropia have an increased prevalence of systemic and ocular abnormalities. Overall success rate with one to two operations was 88%. The need for more than one procedure was high in these patients.