Paralytic strabismus in children is mostly caused by congenital developmental abnormalities, birth injuries and diseases within the first few months of life. We should first look for the cause and ask for consultation from ENT, neurology, brain surgery and pediatrics to exclude diseases such as periocular sinus, brain nerve and intracranial tumor to accurately diagnose the primary cause and prevent delay in treatment. Paralytic strabismus is a condition in which one or more of our extraocular muscles have a lower than normal muscle strength for some reason, causing an imbalance in the strength of the extraocular muscles. There are two types of strabismus, congenital and acquired. Generally, congenital strabismus is usually caused by congenital neurodevelopment or birth injury. Most of the acquired cases are caused by trauma, swelling, infection, etc.