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To investigate the timing and effect of surgical treatment of diplopia caused by hypertrophic inferior rectus in patients with Graves' ophthalmopathy and pathologic changes of inferior recti.Eleven diplopic patients with restrictive superior motion and enlarged inferior recti confirmed by CT scan were collected, and the inferior recti were recessed. Specimens of inferior recti obtained during operation were stained by HE, PAS and observed by light microscope.There was no diplopia after operation when patients looked down and horizontally in eleven cases. Eye position was normal. HE and PAS stain showed stiffness of muscular fiber, small muscular cell with degeneration, obvious proliferation of fibrous tissue in endomysium, perimysium and epimysium, which enlarged extraocular muscle.Poor function of inferior recti due to enormous proliferation of fibrous tissue and degeneration of muscular fiber results in the occurrence of diplopia. Recession of inferior recti can eliminate patients' diplopia.