BACKGROUND: Binocular vertical rectus muscle recession has not been formally evaluated in the correction of comitant vertical strabismus. METHODS: Eight patients with stable comitant vertical strabismus for at least 6 months were included. All underwent recession of the superior rectus muscle of the hypertropic eye combined with an equal or nearly equal recession of the inferior rectus muscle in the hypotropic eye. On the day before surgery, on one of the first three postoperative days, and at one year postoperatively, ocular alignment in vertical and horizontal gaze directions were measured with simultaneous and alternate cover test at a viewing distance of 5 meters, and with the two dimensional Hess screen test. The field of single binocular vision was determined with a Goldmann perimeter. The Lang stereopsis chart was presented at the last follow-up visit. RESULTS: All patients were orthotropic at the last postoperative follow-up visit. In primary gaze, the degree of vertical and horizontal phoria diminished significantly. Normal alignment was achieved in nearly all gaze directions and stereopsis was reestablished. The field of single binocular vision enlarged after the surgery. CONCLUSIONS: Binocular vertical rectus muscle recession is an effective surgical approach for patients with comitant vertical ocular misalignment.