With limited information in the literature regarding simultaneous surgery in cases with superior rectus (SR) contracture in superior oblique (SO) palsy, the authors aimed to evaluate the efficacy of combined SR/IO surgery. This was a retrospective study of 15 cases with a mean follow-up of 50.4 months. Twelve congenital and three acquired cases of SO palsy were included. Diplopia was present preoperatively for five patients. Twelve had preoperative compensatory head posture. The preoperative mean primary angle was 23 ±5.03PD hypertropia. On forced duction test, mild SO tendon laxity was present in six cases and right SR in 15 cases. SR recession of 3-6.5mm (mean 4.86 ±1.18mm) was undertaken on adjustable sutures in 12 patients and adjusted for four patients. For these 12, postoperative mean vertical deviation in primary gaze was 1.41 ±1.88PD. Postoperative overcorrection was noted in three patients ranging from 6-16PD. All were given botulinum toxin injection to the ipsilateral inferior rectus. Overcorrection resolved for two cases; others were masked SO palsy requiring contralateral IO disinsertion. The authors conclude that combined surgery is effective for large angle deviations but carries a risk of overcorrection. In such cases, botulinum toxin provides an appropriate treatment.