Strabismus surgery on tight extraocular muscles poses significant challenges due to limited muscle mobility and increased surgical risks. This study introduces the Suh muscle hook, a novel instrument designed to enhance surgical maneuverability and outcomes in cases of tight extraocular muscles during strabismus surgery. The Suh muscle hook features five unique design enhancements, including an ultrathin profile, a curved handle, a beveled tip, a knobbed tip, and a grooved track for needle passage. These design features aim to improve usability and efficacy in surgeries involving tight extraocular muscles. The Suh muscle hook was meticulously designed by Epsilon. It measures 112.5 ± 0.5 mm in length and incorporates features such as a textured handle for improved grip, a 10-degree angled handle, and a 1.5 mm-wide horizontal bar with a 0.55 mm-wide grooved track for precise suturing. The innovative design of the Suh muscle hook allows for easier manipulation and suturing under tight extraocular muscles, reducing the risk of muscle rupture, scleral perforation, and other complications associated with traditional muscle hooks. The instrument's enhanced maneuverability and safety features contribute to improved surgical outcomes. The Suh muscle hook represents a significant advancement in strabismus surgery, offering a safer and more precise approach to managing tight extraocular muscles. Its unique design features address the challenges posed by tight muscles, ultimately improving surgical success and patient safety in pediatric ophthalmology and strabismus practice.