vertical offset-setting (of the horizontal recti)

Reattaching the medial and lateral rectus muscles at a new scleral insertion point that is vertically displaced from the original insertion, usually between 1/2 to 1 full tendon width higher or lower. Moving the medial rectus insertions downward decreases adduction in downgaze, treating A-pattern esotropia. Moving the lateral rectus insertions upward decreases abduction in upgaze, treating A-pattern exotropia. The opposite vertical transpositions treat V-pattern strabismus by increasing the horizontal deviation in the opposite field of gaze.