AIM:To discuss the clinical manifestation of double depressor paralysis(DDP) and evaluate its surgical method and therapeutic effect.METHODS: Six cases of DDP were retrospectively reviewed from July 2009 to September 2011．To examine the eye position, eye movement, compensatory head posture and forced duction test. All patients were operated on the paretic eye. The superior rectus muscle (SR) was weakened and inferior oblique muscle (IO) transferred. The horizontal muscles operation can be executed at the same time or the next time. Clinical characteristics and surgical procedure and the results were summarized.RESULTS: The clinical characteristics of patients were hypertropia of the peratic eye (≥25△). Significant limitation of lateral-in-fraduction and medial-infraduction was observed. Horizontal deviation can be accompanied. The non-paretic eye is often the fixation eye. Some patients show pseudo-blepharoptosis in the primary position when fixed with the paretic eye. After 6 to 24 months follow-up, 5 patients were cured in one operation and the rest one was greatly improved by the second operation.CONCLUSION: Ocular movement examination is efficient and direct method for DDP diagnosis. The operation project lies on the deviation degree and result of forced duction test. Most patients with DDP gain good results. The operation principles include SR slack, IO transfer, accompanied or unaccompanied with horizontal muscles operation.