AIM:To explore the operative methods and post-operative effects of V-pattern exotropia. METHODS:The operative methods and postoperative effects of 27 cases with V-pattern exotropia treated in our department during January 2004 to December 2008 were analyzed. Operative methods were chosen on the basis of their cause. 18 cases with inferior oblique hyperfunction were treated with inferior oblique reduction and exotropia correction. 9 cases without inferior oblique hyperfunction were treated with inferior oblique reduction and horizontal rectus vertical transporting. Follow-up time after surgey was two months to forty-one months.RESULTS:Twenty-five cases got V sign corrected,24 cases returned to the normal at primary position of eye,2 cases had undercorrection,1 case had overcorrection. 15 cases got different degrees of binocular vision,2 cases got stereoscopic vision. CONCLUSION:Inferior oblique hyperfunction is the main cause of V-pattern exotropia. Inferior oblique reduction and exotropia correction are effective methods. Patients without inferior oblique hyperfunction can be treated effectively with inferior oblique reduction and horizontal rectus vertical transporting.