This is a study of 19 cases of strabismus surgery using topical aesthetic and intraoperative adjustment in selected children. The study included 14 males and five females with mean age of 12.68 ±2.5 years (range 8-16). Five were esotropia and 14 exotropia. Overall, mean preoperative angle was 24.21 ±11.2PD at distance and 22.11 ±11.05PD at near. Seventeen of 19 patients (89%) remained comfortable during surgery. Two needed IV injection of propofol. Overall mean postoperative angle at six months follow-up was 4.11 ±2.87PD at distance and 3.58 ±2.95PD at near. Fourteen of 19 (74%) needed intraoperative adjustment and mean adjustment angle was 4.5PD. Seventeen (89%) reached their target angle (success rate). One was over and one was under corrected. The authors conclude that this approach is tolerable with good outcomes in well-selected children. Assessment of the child is fundamental to determine collaboration during surgery.