The authors evaluated the long-term surgical outcomes and associated factors in patients with the same preoperative angle of deviation in intermittent exotropia after undergoing the same amount of bilateral rectus muscle recession. This was a retrospective review of 102 patients who underwent 6mm of bilateral rectus recession for intermittent exotropia. Success was defined as +/-10PD of ortho. Fifty achieved success and 49 had recurrence. Three were excluded. Mean follow-up of the initial visit to surgery was 16±14.8 months for the success group and 12.8±7.7 months for the recurrence group. In the success group, mean preoperative angle was 29±1.9PD for distance and 31.9±2.7PD for near. This was 28.9±1.8PD for distance and 31.1±3.3PD for near in the recurrence group. Differences in angle were not significant. The success group had 46% with lateral incomitance compared to 26.5% in the recurrence group which was significant (p=0.035). Postoperative angle was 5.8±5.6PD in the success group and 1.4 ±4.6PD in the recurrence group which was a significant difference (p<0.001). At two-year follow-up, the angle was 3.7±3.7PD in the success group and 16.5±5.9PD in the recurrence group which was significant (p=0.001). The angle was more stable in the success group with less exo drift. Presence of lateral incomitance and early postoperative overcorrection were the only factors associated with surgical success. The authors estimated mean time to recurrence of 51.8±3.6 months with >10PD eso and 41±1.7 months with <10PD eso.