You don't say what the exodeviation is in the primary position distance, but I assume it is greater than the 10 prism diopters XT at near.  The girl has poor vision in the left eye so I assume you would like to limit surgery to the left eye, but this would not be a necessary requirement.
Up gaze is not ordinarily crucial and certainly not in any way as important as primary and downgaze.  I assume that the patient suppressed and has no fusion.  A surgical approach could start with a small recession of the left lateral rectus.  To this you could add a 3/4 muscle width upshift for the "V" pattern. This may be all that should be done to avoid an esodeviation at near.  This patient would likely end up with some deviation, though smaller and hopefully less of a problem for her cosmetically.