This study evaluates the amount of effectiveness of inferior oblique myectomy in primary position, lateral gaze and head tilt, and the effect on improving extent of abnormal head posture. The study included 39 patients; 22 male, 25 left-sided palsy and five due to severe trauma. Mean age at surgery was 21.2±15 years with mean follow-up of 7.5±6.7 months. Mean reduction in angle for primary position hypertropia at near was 14.2±7.8PD, at distance 12.4±7.2PD, ipsilateral gaze 5.8±4.5PD, contralateral gaze 18.1±9.3PD, ipsilateral tilt 16.9±9PD and contralateral tilt 7.1±5.5PD. All abnormal head postures resolved. Surgical success was 89.7%. The authors conclude surgery was effective in resolving large hypertropia from unilateral superior oblique (SO) palsy and recommend its use as a first surgery option for patients with ≤30PD due to unilateral SO palsy with minimal SO underaction.