In strabismus surgery, the post-operative visibility of the procedure and level of patient discomfort will mainly be influenced by the number and type of muscles operated on and the type and location of the conjunctival openings. For strabismus surgeries minimising tissue disruption, the term minimally invasive strabismus surgery (MISS) has been introduced. MISS uses several keyhole openings (instead of one large muscle access), which are placed where the main surgical steps will be performed. If necessary, tunnels are created between the cuts for some surgical steps. The openings are always placed far away from the limbus. Post-operatively, such cuts will minimise the risk of corneal complications and remain covered by the eyelids. There is increasing evidence to suggest that the disruption of the perilimbal episcleral vessels, which occurs with a limbal incision, may predispose to anterior segment ischaemia. MISS will preserve the majority of perilimbal episcleral vessels. Since MISS also significantly reduces the anatomical disruption between the muscle and the surrounding tissue, reoperations might be easier and the function of the muscle may be better preserved. MISS openings allow the practitioner to perform all types of strabismus surgeries, namely rectus muscle recessions, resections, plications, reoperations, retroequatorial myopexias, transpositions and oblique muscle recessions or plications.