FIG. 1.

9-gaze clinical photos of a patient with chronic posttraumatic left sixth neve palsy. A preoperative photos show 35PD primary position ET which increased in the down compared to the up gaze (V-pattern ET). Limitation of abduction in the left eye was − 5 which was less evident in the upper lateral gaze compared to lower lateral gaze. B postoperative photos following left dual augmented IRT combined with 4.5 mm medial rectus recession. Primary position alignment improved to 4PD exotropia and limited abduction to − 2. with collapse of V-pattern. Note; the left pupil was pharmacologically dilated