The authors report the surgical treatment of a 15-year old with congenital III nerve palsy. The child had a deviation of 50PD exotropia and a -6 limitation of adduction, -3 limitation of elevation and -4 limitation of depression. Surgery consisted of nasal transposition of both superior and inferior oblique muscles to the medial rectus insertion and absorbable suture globe fixation to the nasal orbital periosteum. This was combined with lateral rectus BT injection. The deviation reduced to 12PD exotropia at six month follow-up.