This clinical report describes how good surgical management could be made in a case of large angle esotropia with abnormal retinal correspondence (ARC) in adult.A 22-year-old-man came to our clinic for contact lens prescription on March, 2000. A routine checkup showed esotropia of 50Δ diopters with dissociated vertical deviation, and he was advised a complete strabismus evaluation. Previously, he had visited other ophthalmologists twice. The surgery was not carried out due to risk of paradoxical diplopia after surgery.Although he was found to have unharmonious-ARC with diplopia test, synoptophore and after image test, we confirmed possibility of surgery utilizing suppression area.After second prism-test, surgery was planned to correct 20Δ diopters which was limited angle of suppression area. Two months after surgery, he was not a ware of paradoxical diplopia and he was satisfied with result.