Incomitant strabismusStrabismus presents a unique surgical challenge due to its varying ocular deviation across different directions of gaze. Achieving perfect alignment in all positions is often unattainable, making patient counseling and expectation management essential. This chapter explores the surgical principles guiding the management of incomitant strabismus, emphasizing the importance of prioritizing functional outcomes, particularly single or nearsingle vision in primary and downgaze. Through a series of clinical cases, the chapter illustrates key decision-making strategies, including targeting the muscles that move the eye in the direction of maximum deviation, leveraging the secondary effects of surgery, addressing paralytic muscle dysfunction through transposition techniques, and managing mechanical restrictions. Specific conditions such as fourth and sixth nerve palsies, myopic strabismus, thyroid eye disease, and posttraumatic or post-surgical restrictions are discussed in detail, with a focus on tailored surgical interventions. By outlining a structured approach to surgical planning, this chapter provides ophthalmologists with practical insights to optimize outcomes in patients with incomitant strabismus.