Background: Monocular Elevation Deficiency (MED) is an inability to elevate one eye in all field of gazes usually resulting in one eye that is pointed downward relative to the other eye. Objective: To evaluate the efficacy of inferior rectus recession in management of monocular elevation deficit (MED) with +ve or –ve forced duction test (FDT). Patients and Methods: Our study was carried out on 20 patients complaining of MED who were selected from out-patients clinic in Sayed Galal and Al-Hussein University Hospitals. From January 2017 to May 2019. The patients were divided into 2 equal groups. Group A with +ve FDT, and group B with -ve FDT. Both groups had inferior rectus recession (IRR). Results: Preoperatively, 40% of patients in group A were -4 (limited elevation), and 60% of patients were -3. All those patients improved to -1 postoperatively. On the other hand, 90% of patients in group B were -4, and 10% of patients were -3 (limited elevation). They improved postoperatively to -3 and -2 respectively. In group (A), the average of preoperative hypotropia was 19.40 ± 1.43PD. All the patients had IRR:  the postoperative average of hypotropia was 1.10 ± 1.91PD with average of correction 18.30 ± 1.42PD. In group (B) having MED with -ve FDT were operated by IRR. A reliable and effective correction of hypotropia in 7 patients with preoperative mean deviation of 19.86 ± 1.68PD, and postoperative mean deviation of 2.71 ± 2.56 PD with average of correction 17.14 ± 1.86PD. Partial correction of hypotropia in 3 patients underwent Knapp's procedure with preoperative mean deviation of 50.0 ± 5.00, postoperative average of correction of 18.00 ± 0.00 PD, post Knapp procedure the deviation was 3.00 ± 2.65 with average of correction of 29.00 ± 2.65. Conclusion: Although the MED is etiologically multifactorial, satisfactory surgical results can be achieved by IRR as a simple and reliable 1ry intervention for both types (+ve FDT and –ve FDT).