BACKGROUND: According to Hering's law, the induced palsy of an extraocular muscle will result in an increased innervational flow to this muscle as well as to its contralateral synergist. A retroequatorial myopexy (Cüppers Faden Operation), with or without muscle recession, can be considered as an iatrogenic palsy. METHODS: Two patients, aged 16 and 5 years respectively, presented with hypotropia, the deviated eye showing limited ocular movements in elevation and pseudoptosis of the upper eye lid. Both patients underwent surgery, this consisting of a posterior fixation and recession of the superior rectus of the sound eye. RESULTS: After surgery, both cases showed a stable improvement of the opening of the palpebral fissure and of the vertical deviation. CONCLUSIONS: This surgical procedure was already described by Cüppers and, although rarely performed, does represent a useful surgical alternative in cases of partial ptosis of the upper eye lid together with hypotropia.