To develop a Persian version of the Adult Strabismus Questionnaire (AS-20) and use the new questionnaire to evaluate the effect of strabismus surgery on health-related quality of life (HRQOL).

The reliability of the final version was tested with the test-retest and internal consistency methods. The construct and criterion (concurrent) validity were also tested for the questionnaire. Then, 112 patients with strabismus completed the questionnaire 1 week before and 3 months after strabismus surgery.

The patients with preoperative diplopia had significantly poorer median preoperative total and functional scores than the patients without preoperative diplopia (p = 0.04 and 0.009, respectively). In the cases with and without diplopia, the median total, psychosocial, and functional postoperative scores were significantly better than preoperative scores (p = 0.01, 0.01, and 0.028, respectively, in diplopic cases, and p50.0001 for all scores in non-diplopic cases). The females had significantly poorer median preoperative total, psychosocial, and functional scores (p = 0.001, 0.02, and 0.0001, respectively) and more postoperative total, psychosocial, and functional score improvement than males (p = 0.004, 0.003, and 0.03, respectively).

The significant increase in the total and subscale scores after strabismus surgery showed the importance of strabismus surgery in improving HRQOL of the patients, especially in psychosocial aspects.