We reviewed the surgical records of 77 patients who had undergone 7-mm bilateral medial rectus recessions for large-angle congenital esotropia. The mean age of onset of esotropia in these patients was 3.5 months, and the mean age at the time of surgery was 12.9 months. The mean preoperative deviation was 69 delta of esotropia. This procedure resulted in satisfactory horizontal alignment in 47 patients (61%) at their latest follow-up examination (mean, 27 months; range, 6 months to 6 years). The esotropia was undercorrected in 21 patients (27%) and overcorrected in nine (12%). Amblyopia was noted in 30%, oblique muscle dysfunction in 44%, and dissociated vertical deviation in 36% of the patients. Regression analysis of multiple variables showed alignment at 6 weeks to be the only predictor of the final outcome (R = .83). Extramacular fusion was achieved in 10 of 11 patients for whom reliable sensory data were available. The mean age at surgery of these patients was 9.7 months. Seven-millimeter bilateral medial rectus recessions are an effective alternative to three- and four-muscle procedures in the initial treatment of large-angle congenital esotropia during infancy.