To assess the effect of combined resection and recession on the same lateral rectus muscle in patients with true divergence excess sensory exotropia.Patients were divided into two groups. One group of patients underwent combined resection-recession of the lateral rectus muscle in one eye (LR group); the other group, with exodeviation of >40Δ for distance underwent additional ipsilateral medial rectus resection (LR + MR group). Postoperative measurements were taken at 1 week, 1 month, and 3 months.Eleven patients were included in the study (mean age, 23.5 ± 6.7 years): 7 in the LR group and 4 in the LR + MR group. For the LR group, mean preoperative deviation was 35.7Δ ± 3.5Δ at distance and 16.3Δ ± 3.9Δ at near. The mean near-distance disparity (NDD) was 11.4Δ ± 2.7Δ. The mean lateral rectus recession was 8.6 ± 1.1 mm: the mean resection, 4.3 ± 0.5 mm. At 3 months, mean deviation at distance was 8.3Δ ± 2.1Δ; at near, 3.1Δ ± 1.6Δ (P = 0.01). The NDD was 5.7Δ ± 2.7Δ (P = 0.01). For the LR + MR group, mean preoperative deviations at distance was 65.0Δ ± 12.9Δ; at near, 35.0Δ ± 12.2Δ. The mean NDD was 30.0Δ ± 4.0Δ. Mean lateral rectus recession was 9.5 ± 1.8 mm; the mean resection, 4.8 ± 0.8 mm. The mean medial rectus resection was 5.5 ± 0.6 mm. At 3 months, mean deviation at distance was 8.3Δ ± 2.1Δ; at near, 3.1Δ ± 1.6Δ (P = 0.06). The NDD was 5.7Δ ± 2.7Δ (P = 0.06).In our study combined resection and recession of the same lateral rectus muscle in patients with divergence excess sensory exotropia significantly reduced the NDD, with no adverse outcomes.