The first stage in the management of decompensated heterophoria is to determine the reason for decompensation. Sometimes, a change to the working environment or a correction of the refractive error is all that is needed to eliminate the symptoms. Many cases of decompensated heterophoria can be treated with eye exercises and this is often the treatment of choice, particularly for exophoric deviations. Decompensated heterophoria can also be corrected using prisms or by refractive modification. In refractive modification negative lenses are prescribed for exophoria and positive lenses for near esophoria. This approach can be useful in pre-presbyopes, even if emmetropic. Methods of prescribing spherical and prismatic lenses to correct decompensated heterophoria are reviewed.