Surgical strabismus traditionally attended for several face-to-face (FTF) measurements before being listed for surgery. During the Covid-19 pandemic, a streamlined care-pathway was adapted to reduce FTF contact time to protect staff and manage floor-flow. Patients were listed for surgery after just one face-to-face orthoptic assessment, followed by a further measurement at pre-assessment.

This is a case cohort to look at surgical outcome of all consecutive exotropia patients who underwent re-do horizontal muscle surgery over the last 14 years, from a surgeon’s prospective database.

65 patients had surgery before the pandemic (Group-A) and 28 since the pandemic (Group-B). The mean age was 34.9 and 39.1 years respectively. The mean pre-operative near-angle was 37.5 prism dioptres (PD) and distance-angle of 34.8PD for group-A. Group B was 39.3PD for near and 36.3PD for distance. 89.1% in group-A and 89.2% in group-B had suppression. Postoperative alignment within 15PD was achieved, after a combination of fixed and adjustable procedures, for 75.4% in group-A and 88.5% in group-B with predominant adjustable procedure. The mean 2-weeks post-operative alignment was -1PD for group-A and -1.3PD for group-B. Group-A had an average of 3.6 measurements, with 3.3 doctor consultant prior to surgery and group-B had 2 FTF orthoptics and 1 FTF doctor contact.

44.4% reduction in face-to-face orthoptics contact-time and 69.7% less consultant contact-time had not negatively affected the patient surgical outcome.

Strabismus surgery can be considered in selected cases with less FTF pre-operatively and improve cost-efficiency of our adult strabismus service with ‘block-contract’ status.