AIM: To compare outcomes of conventional and Hang-back methods of inferior oblique (IO) recession in V-pattern strabismus with inferior oblique overaction (IOOA). METHODS: Comparative randomized study was conducted consisting of 50 patients, age 6 to 35y having V-pattern strabismus [>15 prism diopter (PD)] with IOOA. They were divided equally in two groups and underwent IO recession, group A by conventional method and group B by Hang-back method. Parameters evaluated were reduction in V-pattern and IOOA, shift in torsion, improvement in binocular status. Success was a residual V-pattern of less than 10 PD at 1y of follow up. RESULTS: The mean V-pattern preoperatively and postoperatively at 1y was 24±5.4 PD and 4.2±3.51 PD in group A and 23.44±6.44 PD and 5.76±3.8 PD in group B respectively. The mean reduction in V-pattern was 20±6.78 PD in group A and 18.2±5.48 PD in group B. The mean correction of IOOA was 18.48±3.13 PD in group A and 16±2.93 PD in group B. Mean shift in extorsion was 3.08±1.8 degree in group A and 3.72±2.14 degree in group B. CONCLUSION: Both the procedures achieve a significant and comparable reduction in V-pattern and IOOA. Hang-back recession being a landmark free surgery eliminates the need for intrascleral suturing thereby reducing the risk of scleral perforation with possible postoperative adjustment of muscle. It may be considered as a good alternative for IO recession in patients of V-pattern strabismus with mild to moderate amount of IOOA.