We report the surgical correction of a case of strabismus showing reverse directional deviation. A 9-year-old girl showed reverse directional strabismus according to fixation distance. We performed a posterior fixation suture on the medial rectus 12 mm posterior from the scleral insertion and temporal superior oblique tenotomy. The follow-up after 18 months was as follows: The esotropia at near was reduced from 12 prism diopters to 4, whereas there was no change in the amount of exotropia at distance. The 24 prism diopters A type vertical incomitance was converted into 2 prism diopters V type vertical incomitance. The posterior fixation suture on the medial rectus was effective in reducing esotropia at near but there was no effect on exotropia at distance.