Purpose: To review the results of adjustable suture surgery in patients with strabismus secondary to thyroid ophthalmopathy to determine long-term outcome and to identify postoperative complications. Methods: The records of 1524 patients with thyroid ophthalmopathy were retrospectively reviewed to identify those who required treatment for strabismus in the ocular motility clinic. Treatment consisted of adjustable suture surgery, prisms, or both. Elimination of diplopia in primary and reading positions was used at the criterion for success. Results: Forty-seven patients were treated with adjustable suture surgery, with an average follow-up of 41 months. Results after 1 or more surgeries were: 47% excellent, 26% good, 19% fair, and 9% poor. Significant postoperative complications included eyelid retraction and A-pattern exodeviation. Sixteen of 18 patients with fair or poor outcomes after the initial surgery were recognized within 6 months. Postoperative changes in vertical deviation from primary position to downgaze were predictive of postoperative diplopia in downgaze. Analysis of multiple preoperative characteristics showed no statistically significant associations with outcome. Eight additional patients had adequate relief of diplopia using prisms alone, with an average follow-up of 49 months. Conclusion: Long-term symptomatic relief of diplopia was obtained in the majority of patients using adjustable suture strabismus surgery, combined occasionally with small amounts of prism postoperatively. Prisms alone provided effective long-term relief in patients with small-to-moderate deviations.