Background: strabismus is a condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles. Strabismus can present as manifest (heterotropia), apparent, latent (heterophoria) varieties. Objective: the present study aimed to compare the minimally invasive strabismus surgery (MISS) as an alternative to limbal approach for horizontal concomitant strabismus. Patients and Methods: the study included 50 patients of different ages and sexes, presented with transverse strabismus, for elective surgical correction. They allocated into two equal groups; the first group included 25 cases who were managed by MISS (patients group); the second group included the other 25 cases who were managed by limbal approach (control group). Results: the results were evaluated at one week, three week and six week as regards to visibility of surgical wound, post-operative conjuntival redness, patient discomfort, surgical opening related complications and post-operative correction at first week, third and six months. Few complications were seen with the MISS technique and they were mostly related to the surgery not to the technique itself. Conclusion: the minimally invasive strabismus surgery has the same effect as limbal approach as obvious by the similar success rate. Its stability is as good as the stability of limbal incision. It has the advantages of sparing perilimbal episcleral vessles which make it a good choice instead of limbal approach whenever there is fear of anterior segment ischemia. [ABSTRACT FROM AUTHOR]