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Purpose: To compare horizontal and vertical split conjunctival autograft technique in the management of double head pterygium. Methods: Retrospective analysis of 96 and 99 eyes with double head pterygia that underwent horizontal (Group 1) and vertical (Group 2) split conjunctival autografting, respectively. Comparison of recurrence rates and other complications was done. Results: Recurrence was seen in 5.2% and 4% of the eyes in Groups 1 and 2, respectively (P > 0.05). Other complications like subconjunctival hemorrhage, graft edema, graft retraction, granuloma, and graft loss were also comparable among the two groups. Conclusion: Both the techniques provide good results with comparable efficacy in terms of rates of recurrence and complication profiles.