Abstract： Objective To explore the changes of ocular surface and meibomian gland function and analysis of risk factors in patients with strabismus after operation.Methods Retrospective case-control study.126 strabismus patients(188 eyes)admitted to our hospital from January 2019 to June 2021 were selected as the research objects.According to the surgical incision,the patients were divided into three groups:limbal incision group(group A),transmuscular end incision group(group B),and near-fornix incision group(group C).The changes of ocular surface and meibomian gland function were observed at 1 week,1 month,and 6 months after operation,respectively.The univariate factors of ocular surface and meibomian gland function changes were also analyzed,and logistic regression analysis was used to further clarify the factors affecting postoperative ocular surface and meibomian gland function changes in patients with strabismus.Results The comparison between groups of OSDI,CFSS,LLT,SIt,TBUT and meibomian gland opening score was statistically significant(Fgroup=35.912,28.093,32.115,35.021,32.984,35.765,P<0.05).There were significant differences between different time points(Ftime point=67.982,69.038,62.091,59.181,64.282,61.224,P<0.05).At the same time,there is an interaction effect between groups and time points of each index(Finteraction=52.126,56.098,55.223,59.719,54.033,49.914,P<0.05).The postoperative recovery of ocular surface and meibomian gland function in patients with strabismus was not related to gender,family medical history,abnormal preoperative stereopsis,and combined amblyopia(P>0.05).The recovery of ocular surface and meibomian gland function in optic patients was related to the age of onset,disease course,uncontrolled orthoposition,no postoperative stereo vision training,surgical incision,and the number of muscles involved in surgery(P<0.05).Further logistic regression analysis showed that the age of onset>9 years old,the course of disease>1 year,the lim-bus incision or transmuscular end incision was performed,the number of muscles involved in surgery was≥2,and there was no postoperative stereo vision training were independent risk factor affecting the recovery of ocular surface and meibo-mian gland function in patients with strabismus after surgery(P<0.05).Conclusions The near-fornix incision in strabis-mus patients had the best postoperative recovery of ocular surface and meibomian gland function.Age of onset>9 years old,the course of disease>1 year,the limbus incision or transmuscular end incision was performed,the number of muscles in-volved in surgery was≥2,and there was no postoperative stereo vision training were independent risk factor affecting the recovery of ocular surface and meibomian gland function in patients with strabismus after surgery.