Strabismus surgery was performed with minimal dissection of Tenons sheath and minimal tissue manipulation compared to conventional methods for patients with pure horizontal strabismus – to evaluate the effect on surgical outcomes. The study included 54 patients; 52% female. Mean age was 20±12 years in the case group and 22±11 years in the control group. There was no difference between groups for general demographics. In both groups, regardless of type of surgery, the angle reduced significantly but with no significant difference between groups. Four patients in the case group and three in the control group required reoperation for residual deviation. The hypothesis was that no difference in outcomes would indicate the Tenon capsule and fibrovascular connective tissues play little role on strabismus correction. The results indicated this was the case with a conclusion that the extraocular muscle is the driving force of eye movement and impacts most on angle change.