الفهرس 
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Abstract
SUMMARY The aim of this study was to evaluate the effect of Z-tenotomy of lateral rectus when combined with conventional recession for correction of exotropia The study was carried out on40patients at any age and moderate to large angle comitant exotropia without any vertical deviations and who met the inclusion criteria divided into 4 groups: group A: exotropia of angle of 20 to 30 prism diopters where one lateral rectus muscle was recessed for 7-8 mm group B: exotropia of angle of above 30-40 prism diopters +where one lateral rectus was recessed for 7-8 mm combined with ztenotomy group C :exotropia of angle of above 40-50 prism diopters where both lateral rectus were recessed for 7-8 mm group D :exotropia of angle of above 50-70 prism diopters where both lateral rectus were recessed for 7-8 mm combined with ztenotomy All cases underwent complete ophthalmological and strabismus examination before and after surgical treatment. and completed 3 monthsfollow-up at one day, one week, one month, three months The goal was to augment the effect of weakening on recessed rectusmuscle. If the rectus muscle is recessed more than the values of