Lateral rectus palsy with hypotropia constitutes a portion of sixth nerve palsy cases in which only the superior part of the lateral rectus is affected. We present such a case in a 10-year-old young Pakistani lady who presented with a peculiar appearing right esotropia and hypotropia due to acquired lateral rectus palsy along with apparent ipsilateral superior rectus underaction. Neuroimaging confirmed atrophy of the superior part of lateral rectus as compared to the inferior half. The superior rectus muscle was normal, along with other extraocular muscles. This confirmed our suspicion of superior compartment LR palsy. Augmented superior rectus transposition to the lateral rectus along with adjustable bimedial recessions and bilateral inferior oblique myectomies were done to restore her cosmetic appearance.