To evaluate the prognostic factors that contribute to favorable surgical outcomes of single-stage adjustable strabismus surgery in thyroid eye disease.

Retrospective review of clinical case notes were done of all patients who had surgical treatment for strabismus related to thyroid eye disease under the care of a single hospital between January 2005 and December 2012 (n = 30). Factors that possibly influenced the outcome were statistically analyzed for significance. "Successful" surgical outcome was defined as patients whose residual deviation was within 8 prism diopters and free from diplopia in the primary position on postoperative 1 year.

Mean preoperative vertical deviation was 17.5 prism diopters (PD) and horizontal deviation was 20.3 PD. Mean follow-up time was 12.4 months. Twenty-four patients (80.0%) had successful surgical results. Four patients (13.3%) needed further surgery due to recurrence of previous strabismus and two patients (6.7%) needed prism glasses due to remaining strabismus. Previous history of proptosis ( p = 0.02), optic neuropathy ( p = 0.01), intravenous (IV) steroid pulse therapy ( p = 0.02), number of times of IV steroid pulse therapy ( p = 0.01), and orbital decompression surgery ( p = 0.03) were different between success and failure groups.

Single-stage adjustable strabismus surgery under topical anesthesia showed a success rate of 80% for strabismus patients with thyroid eye disease. Patients who previously had proptosis, optic neuropathy, IV steroid pulse therapy, and orbital decompression surgery significantly showed unsuccessful results after strabismus surgery.