BACKGROUND Simultaneous eye muscle and lens surgery in patients with strabismus and lens abnormalities offers the advantage of avoiding staged surgery. METHODS Thirty-three combined strabismus and lens surgeries were performed on 30 patients who ranged in age from 22 months to 91 years. Fifteen of the strabismus procedures were performed for esotropia, 12 for exotropia, 4 for vertical deviations, and 2 for combined vertical-horizontal deviations. Surgical amounts often were reduced to lessen the risk of overcorrection, to minimize anesthetic requirements (when using topical rather than general anesthesia), or to avoiding additional surgery on the contralateral or ipsilateral eye. The intraocular surgeries included cataract extraction without or with posterior chamber intraocular lens, secondary intraocular lens implantation, and YAG laser posterior capsulotomy. In 28 cases, muscle and intraocular surgery was performed on the same eye, and in 5 cases the strabismus surgery was performed on the eye opposite the intraocular surgery. RESULTS The average length of postoperative follow-up was 23.2 months (range, 1-94 months). Surgical, anesthetic, and postoperative complications, other than unsatisfactory ocular alignment, were limited to one retinal detachment in a patient with persistent fetal vasculature. Strabismic undercorrections (>12(Delta) of horizontal deviation or >5(Delta) of vertical deviation) occurred in 11 cases (37%). There were no overcorrections. A poor visual response (<20/50) to the intraocular surgery was encountered in 6 patients, all as the result of amblyopia or preexisting vitreoretinal pathology. CONCLUSIONS Simultaneous extraocular muscle and lens surgery is an option for patients with strabismus and lens abnormalities. Standard strabismus surgical amounts are recommended.