Strabismus is a disabling aspect of thyroid orbitopathy. Whilst horizontal deviations can be corrected relatively simply, the propensity for inferior rectus involvement makes vertical deviations common. Because the deviations are usually incomitant, prisms have a limited role in management, and surgery is frequently indicated after stability has been documented for at least 6 months. Careful pre-operative discussion of the goals and limitations of strabismus surgery is of paramount importance since a degree of limitation remains postoperatively, even after two or even three surgeries. Nevertheless, with careful planning and duction-testing, a satisfactory central field of binocular single vision can be achieved in the primary position and downgaze, returning this group of patients to a comfortable binocular status for the majority of their day-to-day life.