This study aims at evaluating the muscle scleral plication technique and comparing it to the resection technique. The study included 60 patients having horizontal deviations, they were divided into two groups; group I included 30 patients who underwent muscle scleral plication, and group II included 30 patients who underwent resection. The patients were followed for 3 months and the results of the 2 groups were compared and analyzed statistically. The plication appeared to be safe, effective, and predictable alternative to resection with few complications. It reduces anterior segment ischemia and prevents muscle loss.