AIM:To investigate the clinical features and results of the operations of V-strabismus with inferior oblique hyperfunction. METHODS: Totally 69 cases V-strabismus with inferior oblique hyperfunction admitted to hospital from February 2009 to December 2010 were selected to undergo the surgery of inferior oblique weakening joint horizontal muscle, to observe the changes of eye position before and after surgery as well as the oblique. RESULTS: Postoperative eye anteroposterior in 65 cases (94.20%), the V-sign disappeared in 64 cases (92.75%), 19 cases (27.54%) with compensatory head position all improved, 15 cases (21.74%) performed postoperative machine training to restore binocular vision function. CONCLUSION:The inferior oblique hyperfunction is the main cause of V-strabismus, the surgery of inferior oblique muscle weakening is an effective approach for the treatment of V-strabismus.