Background: Surgical procedures for the treatment of intraosseous adhesions [IOOAs] have included a variety of approaches, such as disinsertion, recession, myectomy, and anterior transposition.
The Aim of the work: This study aimed to compare between inferior oblique muscle standard anteriorization versus myectomy in primary inferior oblique over action.  
Patients and Methods: This prospective comparative non randomized interventional study was conducted on 40 eyes. Patients were divided into two equal groups, Group A were treated by inferior oblique standard anteriorization, and Group B were treated by inferior oblique myectomy
Results: In terms of the degree of IO overaction, at the baseline the two groups were comparable with no significant difference [P =0.7], 30% of the patients in group 1 versus 40% of the patients in group 2 were mild, 55 % of the patients in group 1 versus 45% of the patients in group 2 were moderate, and 15 % of the patients in group 1 versus 15 % of the patients in group 2 were severe. At 1-week post-operative the IO overaction was disappeared in all patients except one patient in group 2 was +1 IO. At 1^, 3, 6 months postoperative, The IO disappeared in 90% of patients in both groups, 5% of the patients in group 1 versus 10% of the patients in group 2 were +1 IO, and only 5% of the patients in group 1 were +2 IO.
Conclusion: We have found both standard anteriorization and distal myomectomies of the inferior oblique muscle to be equally successful in weakening the inferior oblique muscle overaction but in severe cases [+4 IOOA].