Divergence insufficiency is an unusual form of strabismus with esotropia and diplopia only at distance and single binocular vision at near. This retrospective case series describes the diagnosis and treatment of 7 patients and differentiates this clinical entity from other conditions.Seven healthy patients aged 9 to 41 years who developed acquired esotropia only at distance were treated with unilateral or bilateral medical rectus recession.All patients had resolution of diplopia, although one patient initially treated with unilateral medial rectus recession required a second recession of the other medial rectus muscle.Divergence insufficiency is a distinct clinical entity in otherwise healthy patients, which can be successfully treated by unilateral or bilateral medial rectus recession.