This is a small case series of three patients with unilateral or bilateral high myopia with exotropia and hypotropia. Surgery involved nasal loop myopexy between the medial and superior recti muscles with or without lateral rectus recession and / or medial rectus resection – all operated under local anaesthesia. Surgery was based on documentation of temporal displacement of the superior rectus insertion and downward slanting course of the medial rectus. Elevation in abduction improved in all three cases along with an improved strabismus angle. The authors note that ophthalmologists need to explore the course of the superior rectus muscle in such cases.