The purpose of this study was to evaluate the course of over-elevation in adduction in patients who had surgery for esotropia. Following a chart review, 28 patients met the inclusion criteria with a mean age of 53.5±53.7 months (12-252 months). Twenty-two had infantile esotropia and six were partially accommodative esotropes. Follow-up was for a mean of 16.3±7.9 months. Surgery was with bilateral medial rectus recessions. Eighty-two percent achieved surgical success with further surgery planned for four patients. One declined surgery. Mean preoperative angle was 48.2±10.3PD reducing to 8.4±12.9PD. The mean preoperative inferior oblique overaction was +2.1±0.7 reducing to +0.8±0.9 which was significant. Final examination showed that over elevation in adduction regressed in 81% of which 34.6% completely resolved without inferior oblique surgery. Limitations of this study were its retrospective design and small sample size.