In the clinic, parents often ask, “Doctor, when is the best time to operate on my child’s strabismus? Is it better to wait until after 18 years old when he can receive local anesthesia?” There are two views on the timing of strabismus surgery in children. One view is that strabismus should be done as early as possible, based on the theory that strabismus occurring early in visual development can lead to permanent loss of drive cells in both eyes, making visual development in both eyes impaired. Moreover, early correction of strabismus can better correct the eye movement abnormalities associated with congenital strabismus. Another viewpoint is to advocate doing it later for the following reasons: children may have unstable strabismus, and due to their young age, they do not cooperate well with the preoperative examination and cannot accurately measure the strabismus. The surgery is performed under general anesthesia and the surgeon is unable to adjust the eye position intraoperatively, which may increase the risk of re-operation. So how exactly do we choose the timing of surgery? From the point of view of medical development and the higher demand for binocular vision in patients’ future study, work and life, children’s strabismus surgery should of course be done early! However, the timing of surgery must vary from person to person and from disease to disease, so that individualized treatment can be achieved, the success rate of surgery can be improved, and the risk of re-operation can be minimized. According to doctors’ experience and relevant clinical studies, let’s take a look at the timing of surgery for the following types of childhood strabismus respectively: 1. congenital paralytic strabismus, especially in patients with the most common congenital superior oblique muscle palsy, should be operated as early as possible after detection and determination; 2. congenital internal strabismus with a large strabismus (>40 degrees), after giving hyperopic refractive correction and excluding the adjustment factor, 2-3 times of continuous observation (generally 2-3 months between follow-up visits), the strabismus is more stable and should be operated as early as possible, preferably before 2 years of age; 3. congenital exotropia, observed 2-3 times consecutively (generally 2-3 months between follow-up visits), the strabismus is more stable and should be operated as early as possible, preferably around 2 years of age; 4. intermittent strabismus, close observation of the frequency of strabismus, the ability to control strabismus, and stereopsis reduction to determine the appropriate For perceptual strabismus caused by congenital fundus disease or ocular trauma resulting in loss of vision in one eye, the timing of surgery can be selected according to the patient’s requirements for aesthetics.