Introduction: Dexamethasone is given to the patient during surgery to decrease the possibility of post-operative nausea and vomiting (PONV), alleviate pain, and make the patient feel better. Dexmedetomidine is a strong and highly selective alpha 2-adrenoreceptor agonist utilized nowadays in the ICU as a continuous infusion for sedation and analgesia. Aim of the work: This study aimed to compare the effectiveness of pre-operative injection of dexmedetomidine or dexamethasone in sub-tenon block (STB) in conjunction to bupivacaine anesthesia under general anesthesia on reducing pain in the immediate postsurgical period (VAS)  emergence agitation, hemodynamic stability and attenuating airway reflex to extubation in cases who were undergone strabismus operations. Patients and Methods: This study was conducted on a total of 80 cases who were divided into two groups (n=40). Group I received sub-tenon mixture of, bupivacaine 0.5% (2 ml) and dexmedetomidine 0.5 μg/kg (1 ml). Group II received sub-tenon bupivacaine 0.5% (2 ml) and dexamethasone 0.1 mg/kg (1 ml). Postoperative pain (POP) was evaluated by using a verbal pain scale (VPS). Emergence agitation (EA) was assessed with the PAED scale. Results: Dexmedetomidine was associated with a lower analgesic requirement, minimal VAS score and lower emergence agitation and lower complications compared to dexamethasone. Conclusion: Dexmedetomidine as an adjuvant to STB in conjunction to general anaesthesia had promising outcomes in pain reduction, lower analgesic requirement and emergence agitation and low possibility of complications compared to dexamethasone.