PurposeTo monitor the outcomes of surgical correction of esotropia in order to improve preoperative counselling for patients and their families.MethodsA retrospective review audit of the medical charts at King Fahad Medical City. All patients treated surgically to correct esotropia, from January 2007 to December 2013. All operated cases were included regardless of age and esotropia etiology. The study used a goal-determined metric to assess the outcomes of strabismus surgery > 6 months post-operatively, and on last follow-up. The risk factors for poor surgical outcomes were identified using a Pareto chart.ResultsA total of 99 cases with sufficient documentation to determine the surgical goal were included in the analysis. The goal was to improve eye contact (cosmetic correction) in 77.8% cases, to establish binocularity in 15.2% cases, to resolve diplopia for 4% cases, and to improve anomalous head posture for 3%. The overall outcome was excellent for 70.7% at the first follow-up and for 57.6% at the final visit. Simultaneous vertical muscle surgery and/or superior oblique muscle palsy were risk factors for poor outcome (odds ratio 3.15, 95% CI 1.11–8.99).ConclusionsExcellent outcome of esotropia surgery in this study is comparable to outcomes reported internationally using the goal determined metrics. Quality improvement processes like the Pareto chart are simple to use and helpful for determining the risk factors associated with poor surgical outcomes after esotropia correction from different etiology.