A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa in partial fulfillment of the requirements for the degree of Master of Medicine in Ophthalmology, Johannesburg 2014. / Purpose: The main aim of this study is to evaluate the success of bimedial rectus recessions as a primary surgical procedure for patients presenting with congenital esotropia. Secondly the demographic (age, gender and race) data of the study group is described. Lastly the success of surgery is compared to the age of the patients at the time of surgery. Methods: A retrospective review of 52 patients with congenital esotropia of ≥50Δ was done. All patients underwent bimedial rectus recessions and were followed up postoperatively for a minimum of 6 months. Results: The study period extended from January 1992 - September 2003. 52 Patients were included in the study group. The pre-operative angle of deviation ranged from 50-85Δ. The ages of the patients ranged from 15 months to 22 years, with a mean of 5.3 years and a median of 4 years. The gender distribution was 42% male (n=20) and 58% female (n=28). Surgery was successful (within 10Δ of orthophoria) in 77% (n=40), a partial success (10-20Δ from orthophoria) in 17% (n=9) and a failure (more than 20Δ from orthophoria) in 6% (n=3). No statistically significant relationship was found between the success of surgery and the age of the patients at the time of surgery. Conclusion: This study confirms that a bilateral medial rectus recession, performed as a primary procedure for patients with a large angle (>50Δ) congenital esotropia, has a high success rate. This corresponds to the the outcomes of similar international studies.