The authors aimed to determine whether a correlation exists between the immediate operative alignment and future alignment in fixed suture strabismus surgery. This study enrolled 54 patients; seven were lost to follow-up so results are presented for 47 cases. Mean age was 46.7 years, 26 were female, 22 had surgery for exotropia, 19 for esotropia and six for hypertropia. Twenty patients had recessions, 10 had resection / plication and 17 had combined recession/resection/plication surgery. Mean alignment of 2PD under correction (83.3% success) was noted immediately postoperative increasing to mean 4.6PD at two to three months follow-up (overall success of 77%; <8PD horizontal and <4PD vertical angles). Of 17 unsuccessful alignments immediately postoperative, 11 (64.7%) were successfully aligned at two to three months follow-up. The results showed poor correlation and instability across the follow-up period. Despite suboptimal alignment immediately postoperatively, many still achieved successful alignment at later follow-up; and vice versa. The authors conclude that immediate postoperative alignment is a poor predictor of future alignment.