Type 1 monocular elevation deficiency is a restrictive form identified by positive results on forced duction testing in elevation, normal elevation forced generation test, elevation of saccadic velocity and absence of poor Bell’s phenomenon. The authors aimed to evaluate the efficiency of inferior rectus recessions, and as a second procedure, contralateral superior rectus recession for treatment of vertical deviation and limited elevation. This retrospective study included 39 patients with a mean preoperative hypotropia of 20.53PD±4.50 at near and 22.21±5.12 at distance. Mean inferior rectus recession was 5.41±1.46mm. At six months follow-up, the mean angle was 4.15±3.53PD at near and 4.76 ±3.38PD at distance. On average, 2.95PD was corrected by 1mm recession. The surgical success was 74.35%; 25.65% had a residual deviation >6PD requiring a second procedure of contralateral superior rectus recession. The preoperative angle for these 10 cases was a mean of 28.77±7.25PD at near and 27±7.44PD at distance, reducing to 15.66±5.09PD at near and 14±4.58PD at distance at six months follow-up from inferior rectus recession and reducing further to 3.44±3.35PD at near and 3.22±2.90PD at distance at six months follow-up from superior rectus recession. Surgical success was obtained for 7 of 10 cases. The authors conclude inferior rectus recession is an effective first choice surgical option for this condition. Where the surgery is insufficient, contralateral superior rectus recessions is an effective procedure.