Abstract
Despite careful preparation for surgery, the strabismus surgeon may be surprised to discover that what seemed to be a perfectly planned and executed operation has left a patient with residual strabismus and even diplopia. Many of these complications can be avoided by considering key confounding factors in advance. These factors include refractive error, the prismatic effects of spectable lenses, and anatomical abnormalities affecting binocularity. Once the surgeon is cognizant of these conditions, it is possible to detect their presence preoperatively and avoid errors in surgical planning.