Evaluating outcomes of bilateral lateral rectus recession (BLR) surgery with BLR plus one medial rectus resection surgery for treating large angle constant alternating exotropia. Methods: 68 exotropic patients were included in this cross-sectional comparative study, that was conducted at Beni-Suef University Hospital. Patients were divided randomly into two equal groups (each group contained 34 patients): Group (1): who undergone bilateral large lateral rectus recession. Group (2): undergone bilateral lateral rectus recession with medial rectus resection. Patients were followed up for 1, 3, and 6 months postoperatively. Results: Insignificant difference was found between both groups regarding best corrected visual acuity and angle of deviation preoperatively. In contrast, a significant difference was documented regarding outcome of surgery and successful rate after ending the follow up period. Conclusion: Three-muscle techniques have shown higher successful rate than two-muscle surgeries.