In a prospective, randomized, masked study we compared the treatment of infantile esotropia using bilateral medial rectus muscle recessions of a graded amount from the insertion to standard 10.5-mm recession from the corneoscleral limbus. Of the patients undergoing recession of the medial recti muscles 10.5 mm from the corneoscleral limbus, 33 of 39 (84%) achieved a final ocular alignment within 10 prism diopters of straight with one operation, compared to 26 of 41 (63%) of the patients undergoing a graded recession from the insertion. The difference was significant (.01 less than P less than .05 by the chi-square test).