This man has had an old esotropia since birth. He also has a deep amblyopia in the left eye, and a left hypertropia. The oblique muscles do not overact and the palpebral fissures are normal suggesting no pulley heterotopy the fact that the obliques do not appear to be overacting suggests that vertical displacement of the horizontal recti would be best.

A surgical plan for this man could avoid surgery on the oblique muscles and include the following:
1) Left eye: MR recession 5 mm  with 1/2 muscle width upshift and recess the superior rectus 5.0 mm
2) Right eye: MR recession 5 mm with 1/2 muscle width upshift