Background and Purpose:The management of adult patients with strabismus is often challenging. These patients usually require time-consuming evaluations. It is common for the patient to have a history of prior surgical interventions. Patients and Methods:Selected evaluation methods and surgical techniques with particular application to the adult strabismus patient are reviewed. Five categories are considered: 1) Sensory testing; 2) Incomitant strabismus; 3) Re-operations and scarring of the extraocular muscles; 4) Anesthesia; 5) Adjustable sutures. Results:Selected considerations are important in the management of adult patients with strabismus. Conclusion:Adult strabismus management requires thoughtful analysis and special considerations, but can be done successfully in most cases with gratifying results both for the patient and for the management team.