The aim of this study was to report the incidence, risk factors, treatment and outcomes of scleral perforation as a vision-threatening complication of strabismus surgery. The review included 12 papers: four prospective, two retrospective, two surveys, one review, two animal studies and one case series. Incidence was reported as 3/1000 (retrospective studies of 4886 patients) to 7.8% (surgery by fellows / residents). Overall, it was at 1.5-2%. Risk factors included muscle recession procedure, myopic eyes, previously operated eyes, surgeon experience, and use of S-24 needles. Treatment comprised cryopexy, retinal laser, cautery, antibiotics or observation only. The outcomes were similar across the various treatment groups.