Abstract
This case series describes three patients who experienced residual diplopia in secondary gaze positions despite successful strabismus surgery and satisfactory alignment in primary gaze. While initial procedures effectively resolved diplopia in the primary position, symptoms remained in secondary gaze and interfered with daily activities. Each patient underwent an additional surgical procedure specifically addressing the residual diplopia, leading to significant improvement or complete resolution of symptoms. These findings highlight that although primary gaze alignment is the primary goal of strabismus surgery, tailored interventions may be required for patients with symptomatic secondary gaze diplopia to optimize functional outcomes and quality of life.