StrabismusStrabismus surgerySurgery, like most surgical procedures, demands thorough preparation and meticulous attention to detail to ensure optimal outcomes. This discussion encompasses peri-operative considerations and the operative process, building on the pre-operative assessment and planning detailed in earlier chapters. A fundamental understanding of the extraocular muscles and their anatomical relationships is crucial for strabismusStrabismus surgeons. Establishing patient expectations through a detailed history is vital in formulating a surgical plan. The primary goal in cases of diplopia is to restore single vision in primary and downgaze positions, while patients with aesthetic concerns but no binocular visionBinocular vision require positioning that ensures a straight appearance and long-term surgical stability. Managing patient expectations is essential, particularly in complex strabismusStrabismus cases where compromises may be necessary. Anticipating and discussing such outcomes with patients can prevent postoperative dissatisfaction. StrabismusStrabismus surgerySurgery principles emphasize the need for stable orthoptic findings, delaying re-do surgeriesSurgery until deviations stabilize, and conducting pre-operative forced duction tests. Specific surgical guidelines include careful handling of conjunctival tissues, limiting medial rectus recession to 6.5 mm and lateral rectus recession to 8 mm, with supramaximal recessionsSupramaximal recession for larger deviations potentially leading to muscle action limitations. Recessions for the inferior and superior rectus muscles should not exceed 5 mm and 10 mm, respectively. These principles and guidelines aim to optimize surgical outcomes while minimizing complications and ensuring patient satisfaction.