We sought to report the results of combined adjustable suture resection and recession of a rectus extraocular muscle in a subset of patients who are asymptomatic in the primary position but diplopic in secondary functional gaze positions.We undertook a retrospective chart review of 12 patients who underwent a surgical procedure consisting of combined resection and recession of the same rectus extraocular muscle on adjustable suture, the amount of recession being double the amount of resection.The amount of incomitance reduced from a preoperative mean of 11.6 prism diopters (PD) to a postoperative mean of 2.9 PD. All 4 rectus muscles underwent operation No significant change in the primary position alignment occurred. Diplopia was eliminated in 11 of the 12 patients postoperatively.The combined adjustable suture resection and recession operation is an effective and easy procedure for treatment of this subset of patients with incomitant strabismus.