The use of superior oblique posterior tenotomy (SOPT) is reported as a primary procedure in five patients with orbital blowout fractures. The mean follow-up was 15.2 months (6-20). Two patients required further surgery because of a larger vertical deviation. SOPT matches the contralateral failure of depression due to inferior rectus weakness without causing significant changes in the primary deviation. The authors propose the benefit of surgery in the contralateral eye away from scarring of the orbital fracture and surgical repair. They propose this as a useful procedure for small vertical deviations where symptoms are mainly in down gaze.