Abstract: Objective To investigate the efficacy and safety of minimally invasive strabismus surgery and traditional surgery in the treatment of strabismus. Methods Clinical data of 68 patients （108 eyes） with strabismus undergoing surgery were retrospectively analyzed. In the traditional group, 33 patients （53 eyes） received traditional strabismus surgery and 35 patients （55 eyes） in the minimally invasive group underwent minimally invasive microscopic strabismus surgery. All patients in both groups were followed up for 6 months after operation. The effect of strabismus correction, postoperative pain, changes in ocular surface status, operation time, intraoperative blood loss and complications were regarded as the observational parameters. Results The cure rate in the minimally invasive group was 94.2%, significantly higher than 75.8% in the traditional group （P < 0.05）. The VAS pain scores at 2 h, 1 d and 7 d after operation in the minimally invasive group were significantly lower than those in the traditional group （all P < 0.05）. In the minimally invasive group, the FTBUT at postoperative 1- and 7-d was significantly less, the increase of non-invasive tear meniscus height at postoperative 1- and 7-d was considerably smaller and the eye redness scores at 1-, 7- and 30-d after operation were remarkably lower than those in the traditional group, respectively （all P < 0.05）. The average operation time did not significantly differ between two groups （P > 0.05）. The intraoperative bleeding in the minimally invasive group was significantly less compared with that in the traditional group （P < 0.05）. No complications were observed in the minimally invasive group, whereas 3 patients developed postoperative conjunctival granuloma and 2 cases presented with obvious scars on the surgical incision in the traditional group （both P > 0.05）. Conclusions Minimally invasive microscopic strabismus surgery has obvious advantages over traditional strabismus surgery, which not only yields less trauma and higher efficacy, but also exerts less impact on the ocular surface, causes less pain, better cosmetic appearance and fewer surgical complications.