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Strabismus is a pathological misalignment of the visual axes that can present in various ways depending on the aetiology and age of onset. In the UK, strabismus affects 2.1% of the childhood population. They usually arise before the age of five years in children but it is possible to present with a completely new onset in adulthood too. Timely, adequate detection and treatment of strabismus is essential in childhood to prevent the development of amblyopia and loss of stereopsis, whilst in adults it can cause profound psychosocial effects. This article describes the optometric investigation and management of strabismus in children and adults.