In two cases of bilateral superior oblique palsy the vertical component of the deviation was more prominent in one eye and the excyclotorsion more prominent in the fellow eye. A tuck of the superior oblique was performed on one eye and an adjustable Harada-Ito procedure on the fellow eye. This combined approach was used to reduce both the torsional and vertical components in these patients with complicated bilateral superior oblique palsies while effecting a more exact resolution of the torsional component.