The aim was to compare lateral rectus resection and plication methods in patients with residual esotropia for postoperative success rate, dose response, ipsilateral medial rectus limitations and reoperation. The study included 57 patients (31 female, 26 male) with 27 plication and 30 resection procedures. This was a double masked randomised trial for measurements pre and postoperatively, and for surgery type. There was no significant difference in groups for age, sex, refraction, visual acuity stereoacuity and history of previous surgery or preoperative angle. Preop measurements were 27.93 ±9.76PD (plication) and 26.43 ±7.57PD (resection) which were not significantly different. There was no significant difference for postoperative angle or for success rate (77% and 85% at six months respectively). There were no cases of postoperative consecutive exotropia. Dose response was not significantly different between groups. The authors conclude that choice of procedure, given no significant differences between groups, can be the surgeon’s choice although plication may be better where there is risk of anterior segment ischaemia.