The purpose was to evaluate the preoperative factors influencing the efficacy of the surgical procedure of bilateral lateral rectus recessions. Fifty cases with at least one year follow-up were included for retrospective analysis. Mean response to surgery was 2.17±0.80 PD/mm recession at one week postoperative, 1.79±0.63 at six weeks postoperative and 1.58±0.75 at one year postoperative. Exo drift was 5.12±7.27PD at six weeks postoperative and 8.02±6.81 at one year. A larger preoperative distance deviation was associated with larger surgical response at six weeks postoperative. Younger age at surgery, shorter interval between onset and surgery and larger preoperative distance deviation were associated with larger surgical response at one year. Exo drift and extent of preoperative distance angle should be considered when determining surgical dose for infantile exotropia.