This retrospective study evaluated outcomes of surgery for patients with sagging eye syndrome (SES) from 1994 to 2014, to determine recurrence rates of strabismus. The study identified 103 cases; 93 requiring surgery for symptomatic small angle strabismus and 10 requiring prisms. The surgery group included 40 males and 53 females with a mean age of 68±12 years. Mean distance angle was 4.2±7.5PD esotropia and 4.7±5.9PD hypertropia. Eighty-four cases used prisms prior to surgery. Diplopia was present preoperatively for a mean of 1602±223 days. Recurrence was noted in 19 cases. The authors propose recurrence of postoperative diplopia was due to progression of the age-related dehiscence of orbital connective tissue rather than surgical over or under correction and conclude that strabismus surgery provides long-term relief of diplopia for the majority of such patients.