We evaluated the one-stage intraoperative adjustment strabismus surgery with adjustable suture under topical anesthesia. Medical records of the patients who had intraoperative adjustment surgery under topical anesthesia for horizontal or vertical strabismus in our hospital from March 1997 to March 2003 with follow-up of 6 months were analyzed retrospectively. Of the 71 patients, 48 patients had exotropia, 16 had esotropia, and 7 had hyper- or hypotropia. The overall success rates were 85.9% at 1 week, 83% at 1 month, 78.9% at 3 months, and 76.1% at 6 months after surgery. The procedure was not stopped in any patients, and no serious intra-operative or postoperative complications were noted. Intraoperative adjustment strabismus surgery under topical anesthesia is a simple, well-tolerated and effective procedure.