This study evaluates the outcomes of bilateral superior oblique posterior tenectomy along with inferior rectus recessions (minimum of 5mm) on the chin-up head position in 13 patients with horizontal nystagmus who had an eccentric null point in downgaze. The study included nine males and four females aged 7.3±4.8 years. The average preoperative abnormal head posture was 30±8.7 degrees. All had infantile nystagmus syndrome. All achieved postoperative improvement of their head posture. There were no surgical complications reported. Eight patients had a complete resolution of abnormal head posture and five had a minimal residual chin-up position. There was no lower lid retraction postoperatively. The authors proposed a dose of inferior rectus recession of -6mm for 20 degree head posture, 7mm for 30 degrees and 7.5mm for 45 degree chin-up head posture. Limitations; this was a retrospective study with no control group. The authors conclude this is a safe procedure and avoids induced cyclotorsion.