A 38-year-old male WEBINO patient with large angle XT who was undergone two strabismus surgeries, one at referral and another one month later at follow-up is presented.

The patient suffered from a large angle XT (more than 130-140 Δ) in primary gaze and also both the bilateral adduction deficit (the right eye partially (-3) but the left eye completely (-4)) and mild nystagmus in the abducting eye were noticeable. He had a minimal amount of convergence probably because of long time very large angle XT. We decided to do a transposition surgery with lateral rectus recession on the left eye and a recession-resection procedure on the right eye. In the follow-up visit (1 month later), the patient had 50Δ XT. So the patient was undergone a transposition surgery in the right eye too.

The day after second surgery the amount of XT was less than 10Δ.

We concluded that although resection- recession procedures were suggested for the management of XTs in these patients, but they usually could be insufficient especially in large angle XTs and so second surgeries would be mandatory. But transposition surgery could effectively alleviate the exodeviation and also the patients’ complaints.