The authors examine the incidence of strabismus following scleral buckle for retinal detachment surgery and the factors that influence the strabismus, its incidence, preventative measures and treatment options. This was a retrospective review of 344 patients (360 eyes) with a mean age of 38.4±18.1 years; 267 male and 77 female. Sixteen had bilateral retinal detachment surgery. In all cases a 2.5mm wide encircling band (Mira 240) was placed over the segmental buckle to augment the buckling effect. Strabismus was noted in 14% at six-week follow-up. Twelve patients complained of diplopia; eight constant and four intermittent. Persistent strabismus remained for 16 patients. The average angle was 25.8±13.4PD (exo and eso deviations) and 6.9±3.9PD (vertical deviations). Prisms were needed by 11 patients and two patients underwent strabismus surgery. The incidence of persistent strabismus was 4.65%. The authors found that width of scleral buckle material and number of extraocular muscles involved with the buckle do not influence the incidence of postoperative strabismus. There was a significant increase in incidence of strabismus with reoperations. Most cases of diplopia could be treated with prisms.