1. The pathogenesis of some specific types of strabismus is unknown, the manifestations are variable, and abnormal innervation and muscle development coexist; the patient’s response to surgery is unpredictable. In order to achieve better surgical results, the surgeon may plan to operate in stages. 2. Some strabismus is complex, with multiple strabismus coexisting (horizontal, vertical and even rotational); if all problems are solved at once, multiple extraocular muscles need to be adjusted, and the human eye has a tolerance limit for the number of muscles involved in a one-time surgery (no more than two straight extraocular muscles can be performed on one eye at the same time), and more than that will easily cause ischemia of the anterior segment of the eye and threaten the safety of the eye. The surgeon will break the surgery into two or more sessions for safety reasons. For the purpose of binocular vision development, children with early onset strabismus need early surgery; this part of the surgery is performed under general anesthesia. However, children’s ability to cooperate and understand the examination is different, and there are also developmental differences, so the same amount of surgery will have different surgical reactions; moreover, general anesthesia makes it impossible to observe and adjust the surgical effect; this makes it impossible for the surgeon to control the surgical effect 100%, and the chance of secondary surgery is higher than that of local anesthesia. 4. For most common strabismus cases, the success rate of one-time surgery is high, but in a few cases, there is still the possibility of undercorrection or overcorrection due to the developmental differences in innervation and muscle strength. The appearance of exotropia after internal strabismus surgery or internal strabismus after external strabismus surgery is called surgical overcorrection; the residual strabismus in the original direction after internal or external strabismus surgery is called surgical undercorrection. The undercorrection or overcorrection can be solved by re-operation after a certain period of observation and stabilization of strabismus. In some cases, the recent effect is very good after surgery, but the strabismus changes over time. This kind of long-term change in eye position cannot be regulated by the surgeon; it is often caused by defects in the patient’s visual reflexes and abnormalities in the central control of eye position; or changes in the developmental process of innervation and anatomical structure. If the strabismus changes significantly and affects the appearance or the exercise of visual function, it also needs to be solved by surgery again. 6.Change of refractive state: refractive state and eye position are closely related, especially the relationship between hyperopia and internal strabismus; the refractive state of children before the age of 7 can have fluctuating changes, if there is a significant increase or decrease in hyperopia and the adjustment of glasses is not timely, new internal strabismus or exotropia can appear. 7. Emergence of new conditions: Some cases have a history of strabismus surgery and the surgery maintains satisfactory results; however, new strabismus may occur due to new conditions such as inflammation of the nerve, insufficient blood supply to the brain, tumor of the brain or orbit, endocrine diseases, etc., which may affect the function of the extraocular muscles. This newly emerged strabismus has no connection with the history of the original strabismus. In conclusion, the success rate of strabismus surgery is high, and the surgery is minimally invasive and very safe; however, a few patients have the possibility of eye position changes and undercorrection or overcorrection. In reality, such cases are rare, but none of them can be excluded. Under- or over-correction and distant changes in eye position can still be achieved with reoperation. We have to be confident in the results of strabismus correction, and almost all strabismus can be well corrected through the joint efforts of the surgeon and the patient.