Most pediatric strabismus is treated surgically; however, the timing of surgery varies for different types of strabismus. Some strabismas are better the earlier the surgery is performed, while others require a variety of factors to be considered, and not all strabismas are operated on immediately upon detection. Generally speaking, the establishment of binocular vision function in normal people begins before school age, and some functions even begin to develop before the age of two or three, and there is no chance of recovery if this developmental time is missed. In children with congenital internal strabismus or congenital exotropia, the strabismus often appears at birth or within 6 months after birth, and the angle of deviation is usually very large. For these children, the earlier the surgery, the better the results, so that the eye position can be restored as soon as possible and the binocular vision, even if it is coarse, can be established, creating conditions for improving the quality of life in the future and increasing the chances of choosing a career. In children with common strabismus, both eyes cannot look at one target at the same time. That is, when looking at something with either eye, the strabismus is focused on the other eye, but the strabismus is the same regardless of which eye is deviated. For this type of strabismus involving both eyes, the timing of surgery requires consideration of a number of factors, including the degree of strabismus, the disruption of visual function in both eyes, and the age of the child. If the strabismus is developing rapidly, the visual function of both eyes is being destroyed, and the child is older, surgery should be performed immediately. Paralytic strabismus is caused by paralysis of the nerve and extraocular muscles that govern eye movements, resulting in the inability to turn the eye normally. Therefore, the cause of this type of strabismus should be identified and treated for the cause. If the strabismus does not improve after more than six months of treatment for the cause, surgery should be considered. For children with strabismus combined with amblyopia or refractive error (including myopia, hyperopia and astigmatism), in principle, amblyopia and refractive problems should be treated first, but it is not necessary to cure amblyopia completely before surgery. For children with strabismus combined with amblyopia, surgery can be considered as long as it is treated until the visual acuity of both eyes is relatively balanced; it is not necessary to correct the visual acuity to 0.8 or 1.0, and amblyopia can continue to be treated after surgery. In addition, some children are older, already 11 or 12 years old, and have had amblyopia in one eye for several years, which is really difficult to cure. However, due to the child’s age, he or she has already missed the time to establish binocular vision, and parents should be clearly informed that surgery at this time can only improve the appearance so that others cannot see the child’s strabismus, but it is difficult to restore binocular vision. For strabismus combined with refractive error, regardless of whether it is combined with myopia, hyperopia or astigmatism, surgery can be performed when the vision of both eyes is adjusted to the basic consistency through vision correction. Therefore, the timing of surgery for pediatric strabismus cannot be generalized and requires regular checkups at the hospital. Once the best time for surgery is missed, the biggest impact on the child is that it is difficult to reconstruct the visual function of both eyes after surgery. At that time, surgery can only improve the appearance, but not restore the stereo vision function. This will have a great impact on the child’s future career choice and life.