Strabismus is relatively common in patients with thyroid eye disease (TED). It is estimated to affect 10%–40% of patients and in most cases is restrictive strabismus. TED related strabismus leads to diplopia, physical disfigurement, and inability to make eye contact, affecting individual well-being, activities of daily living and psychosocial function. Surgical treatment aims to release the restrictions and improve symptoms. It is frequently successful but can be challenging, has limitations, and in many cases, more than one procedure is necessary. Careful pre-operative evaluation and patient counseling are essential for success. The surgical goals are individualized for each patient, considering their binocular potential, magnitude of ocular misalignment, and symptoms. Strabismus surgery for patients with thyroid eye disease aims to achieve single binocular vision in the primary position and downgaze, improving head posture, appearance, eye contact and expanding the field of single binocular vision.