Background: Strabismus surgery serves to align the visual axes to provide binocular single vision, or improve cosmesis, or restore normal eye contact, or enhance the quality of life. Objective: this study aims at evaluating muscle scleral plication technique as regards efficacy, stability, predictability and possible complications and comparing it to the standard resection technique. Patients and Methods: this study was carried out in the Ophthalmology Department in Al-Zahraa University Hospital and Research Institute of Ophthalmology between 2015 and 2018 on 40 patients. Their ages ranged from 1 to 40 years. 28 patients were males and 22 were females. 23 patients were exotropia and 17 patients were esotropia. Results: from this study it was found that the effect of plication is more or less the same as that of resection. But it can be noted that muscle scleral plication offers a safe, predictable, alternative to resection with no especially alarming complications that differ from those of ordinary strabismus surgery. This technique can be used instead of resection whenever there is fear of anterior segment ischaemia (ASI), such as when there is a possibility of operating on more than two rectus muscles or when the patient suffers from blood diseases or dysthyroid ophthalmopathy. Conclusion: from the results of this study, it can be concluded that the muscle-scleral plication technique is an easy alternative to resection that can be used on horizontal muscles especially when anterior ciliary vessels sparing is needed.