The authors report a retrospective study to investigate possible risk factors leading to consecutive exotropia development in patients who underwent two muscle strabismus surgery to achieve an initial alignment within 10PD. The exotropia group included 25 female and 22 males. The non-exotropic group included 22 females and 32 males. Consecutive exotropia was present in 13% on the first postoperative day, 17% at first month and 40% by the end of the first six months. Risk factors included limited adduction, asymmetrical surgery, presence of amblyopia and anisometropia, although it was acknowledged that anisometropia may be linked with amblyopia.