The long-term results of bilateral medial rectus surgery are evaluated in 42 children with development delay. Mean age pre-surgery was 2.9 years with a mean follow-up of 4.6 years. Mean angle of esotropia was 44.29±13.9PD; 57% achieved surgical success; 31% were undercorrected and 12% overcorrected. Ten of 18 children required a second procedure leading to surgical success for two cases. The authors conclude that the decision to choose usual recession amounts versus reduced surgery, remains debatable.