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Medial rectus recession with lateral rectus plication is an effective procedure in reducing diplopia and ocular deviation in unilateral acquired ANP and may be used as a first-line intervention regardless of the initial ocular motility limitation in abduction. The causes are mainly traumatic but remain undetermined in one case out of six. Medial rectus recession with lateral rectus plication is an effective procedure in reducing diplopia and ocular deviation in unilateral acquired ANP and may be used as a first-line intervention regardle