Sir,We read with interest the article titled “outcomes of asymmetric primary inferior oblique (IO) muscle overaction managed by bilateral myectomy and tucking of proximal muscle end: A cohort study.”1 We appreciate the study and the attempt to evaluate this procedure for IO overaction.However, some aspects of the study were not entirely clear, and further clarification may benefit the readers. The authors mention that patients with bilateral IO overaction (IOOA) were included and that both patients with exotropia and esotropia were a part of the study. When the angle of deviation is described pre- and post-operatively, it is not clear if the authors are referring to the horizontal deviation or the hypertropia induced due to IOOA. A fairly large angle in the primary position (mean preoperative angle of 38.0 PD) was found in the study, it is not common to have such a large hypertropia in cases with primary IOOA; hence, we assume that the “preoperative angle of deviation” refers to the horizontal deviation. If that is the case, it may have been better to calculate mean angle separately for those patients with exotropia and esotropia, respectively.In addition, the inclusion criteria state that patient were included if they had bilateral asymmetric IOOA, however, in the discussion, the authors mention that the difference in reduction in the angle of deviation was not significant in unilateral and bilateral IOOA.We agree that tucking of the cut ends of the IO into the tenon's capsule will reduce the chance of recurrence of IOOA. In our experience, graded recessions of the IO or performing an IO anterior transposition in the eye with +4 IOOA and IO recession in the eye with the lesser IOOA also helps in managing this uncommon condition.