Abstract Background: There are many reasons to perform a stra-bismus surgery, either to provide binocular single vision, improve cosmosis, restore normal eye contact and/or enhance the quality of life. Aim of Study: The purpose of this study is to compare between medial rectus muscle plication versus resection when coupled with lateral rectus recession as regard efficacy and possible complications in treatment of exotropia. Patients and Methods: This study was carried out in Ophthalmology Department at Aswan University Hospital between 2019 and 2020 on 40 patients with exotropia. The first 20 pateints were operated by the plication procedure, while, the other 20 patients were operated by the resection procedure. This study was a randomized controlled study. Results: Plication technique was comparable to resection technique as there were no significant differences as regard post-operative results, but plication technique could be safer in prevention of lost muscle and anterior segment ischemia. Also, plication technique was of shorter operation time. Conclusion: MR muscle plication is an alternative easier, safer and faster technique to resection when coupled with lateral rectus recession in treatment of exotropia.