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Traumatic strabismus may result from orbital or head injury (closed or open). Patients may have other complex injuries that delay diagnosis and treatment. Twelve consecutive adult patients with persistent (> 3 month) strabismus after combat-related head, orbital, or eye trauma underwent strabismus surgery on one or both eyes. The main outcome measures were ocular alignment and diplopia resolution at least 6 months postoperatively. Seven of 12 patients (58%) had traumatic vision loss (< 20/200) in one eye in addition to the traumatic strabismus. Strabismus procedures were complicated intraoperatively by previous ocular and orbital surgery in the majority of patients. One patient required an additional procedure to obtain a satisfactory result, and all patients achieved resolution of diplopia and/or cosmetic improvement 6 months postoperatively. Acceptable outcomes at 6 months may be obtained by using customary amounts of muscle recession and resection both horizontally and vertically.