An intimate knowledge of surgical anatomy of the obliquemuscles including their innervation and important relationsanatomy is necessary to know surgical intricacies and toperform a successful surgery. Oblique muscles dysfunctions,their causes and how to diagnose them through goodexamination to avoid tricky cases like bilateral asymmetricalsuperior oblique palsy which is frequently diagnosed asunilateral and discovered after surgery is discussed. The goalof strabismus treatment has been to realign the visual axes inorder to prevent amblyopia, eliminate diplopia, or toproduce, maintain, or restore binocular vision. Additionally,surgeries to improve an abnormal head posture, to eliminateabnormal eye movements or to restore the normalanatomical position of the eyes are well-accepted indicationsfor surgery. Superior oblique can either be strengthened orweakened through surgery on its tendon which has a veryspecial function and anatomy. Strengthening proceduresinclude various surgeries like tendon tucking to strengthenthe whole muscle or Hatada-Ito procedure and its Fell‟smodification to strengthen only the anterior intorting fibersof the muscle. Weakening procedures include tendonelongation through split elongation, chicken suture or Wightsilicon expander and also include muscle recession,tenectomy and tenotomy procedures. Surgical proceduresinvolving the superior oblique tendon are among the mostintricate surgical procedures performed by the strabismussurgeon. Both the complex functions of the superior obliquemuscle and its complex anatomical configuration makesurgery on the superior oblique tendon unforgiving whenproper indications and techniques are not carefully followed.Forced duction testing is essential before and after surgery toensure proper functional outcome.