Purpose: We analyzed the clinical factors and surgical outcomes of patients with intermittent exotropia exhibiting high hyperopia and emmetropia. Methods: Patients with intermittent exotropia who underwent strabismus surgery and were followed-up for at least one year between April 1999 and January 2018 were retrospectively reviewed. The patients were divided into two groups according to their preoperative spherical equivalent refractive error (SERE): a high hyperopia group (≥+4.00 diopters [D], group 1) and an emmetropia group (+0.50 to -0.50 D, group 2). The surgical outcomes of the groups were compared. Results: We enrolled 74 patients, of whom 24 and 50 were included in groups 1 and 2, respectively. In group 1, the mean SERE was +5.00 D (+4.00 to +8.00 D) in the more affected eye and +2.81 D (+0.00 to +7.25 D) in the better eye. In group 1, the changes in SERE at one year after surgery were as follows: +1.24 D in the worse eye and +0.90 D in the better eye (both, p < 0.001). The mean exodeviation at one day postoperatively for distance and near were -1.25 prism diopters (PD) and 0.21 PD, respectively, in group 1, and -4.62 PD and -2.16 PD in group 2. Thus, group 1 exhibited less exodeviation in terms of both distance and near than did group 2 on day one postoperatively. However, no significant group difference was evident at one year postoperatively. Conclusions The surgical outcomes of intermittent exotropia patients with high hyperopia did not differ from those of patients with emmetropia.