Diplopia after cataract surgery has been reported by several authors, but diplopia after recovery from vitreous hemorrhage (VH) has not been described.We examined eight patients with manifest exotropia and binocular diplopia after recovery from dense VH by vitreous surgery. VH was bilateral in three patients and unilateral in five, and lasted for an average of 7.7 years.Visual acuity before vitrectomy ranged from 20/200 to light perception; that after vitrectomy ranged from 20/20 to 20/60. Exotropia was present in all patients after vitrectomy. Additionally, seven out of eight patients had vertical strabismus with an average deviation of 6 prism diopters (delta). Fusion was confirmed in four patients with an average amplitude of 13 delta. Four patients underwent horizontal strabismus surgery. Fusion was present in two before strabismus surgery and in all four after surgery; however, unstable diplopia persisted in three of the four after surgery.Diplopia after vitrectomy for longstanding VH may occur due to fusion impairment comparable to that occasionally seen after surgery for traumatic cataract.