Purpose of review: To examine the common and serious complications of strabismus surgery, emphasizing prevention, identification, and treatment.
Recent findings: Confusions involving incorrect procedures and patients can occur despite the Universal Protocol, but should be preventable and treatable. Damage to structures adjacent to muscles and scleral perforations should be prevented by careful surgical technique and effective magnification. Orbital inflammations and anterior segment ischemia can usually be treated effectively. Slippage of muscles can be prevented by effective suturing and 'lost' muscles can usually be recovered. Conjunctival cysts and wound irregularities can be prevented using meticulous technique, though repeat surgery may be required in some cases. Postoperative alignment may be compromised by variability in preoperative measurements and by long-term drift, especially toward exotropia; outcomes in specific situations, for example, Duane syndrome, Graves' ophthalmopathy, may be particularly problematic. Nausea and vomiting have become much less common, and serious anesthesia complications extraordinarily rare, though asystole may occur as part of the oculocardiac reflex.
Summary: The many possible complications are rare, preventable, and treatable. Generally, surgery almost always improves, if not permanently curing, strabismic deviations.