Anterior segment optical coherence tomography (ASOCT) is a non-contact imaging method that can provide accurate measures of extraocular muscles to limbus insertion distances. The authors evaluated the accuracy of ASOCT for locating horizontal extraocular muscle insertions after strabismus surgery in 31 muscles of 28 patients (20 female) aged 46 ±15 years. Results were for 14 medial and 17 lateral rectus muscles. Muscle insertion was identified on ASOCT for 14 eye muscles of 13 patients. Average measurements for non-identified muscles were 12mm, and 7.5mm for identifiable muscles; a significant difference. Intraclass correlation between ASOCT and surgical measures was 0.771; 0.668 for lateral rectus and 0.879 for medial rectus. The authors found ASOCT was able to measure muscle insertion location in just 45%. This may be due to use in acute postoperative settings in the presence of postoperative tissue swelling. Accurate measures were obtained where insertions were less than 8mm from the limbus. The authors acknowledge the limitations of this study such as small number of measurements and different measurement units between calliper use and ASOCT. They recommend further larger scale studies.