Background <p>Alport syndrome is a hereditary disorder characterized by renal failure, sensorineural hearing loss, and ocular manifestations. Anterior lenticonus is the most pathognomonic ocular feature, whereas strabismus is rarely reported. Intraocular lens (IOL) implantation in such patients can be challenging due to lens capsule fragility and coexisting visual problems.</p> Case presentation <p>We report a patient with Alport syndrome presenting with anterior lenticonus and intermittent exotropia, who underwent sequential bilateral phacoemulsification with multifocal toric IOL implantation. Preoperative examination revealed high myopic astigmatism and reduced visual acuity. Strabismus evaluation showed intermittent exotropia with greater deviation at near. Surgery was performed with meticulous hydrodelineation and careful capsulorrhexis. A multifocal toric IOL was successfully implanted and oriented along the intended axis. At the 6-month postoperative follow-up, uncorrected distance visual acuity was maintained at 0.05 LogMAR (Snellen 20/22) and uncorrected near visual acuity was N5 at 40&#xa0;cm in both eyes; no severe visual disturbances were detected, and no complications such as capsular contraction or IOL decentration were observed.</p> Conclusion <p>Bilateral trifocal toric intraocular lens implantation may provide satisfactory visual rehabilitation in selected patients with Alport syndrome and anterior lenticonus, even in the presence of coexisting intermittent exotropia.</p>