AIM: To evaluate ocular alignment and surgical results of strabismus surgery in neurologically impaired children. METHODS: Files of 33 neurologically impaired squint children were evaluated. Twelve patients had cerebral palsy(CP), 4 had CP with mental retardation, therest had mental-motor retardation of unknown cause. Cycloplegic refractions, type and angle of strabismus, surgeries performed were recorded. RESULTS: Mean follow-up was 34.0±16.5 months. Twenty-three patients had esodeviation, the remaining had exodeviation. In 19 patients, angle of deviations measured at different visits were highly variable. Twelve patients with stable angle of deviations or with unstable but high angle deviations had horizontal muscle surgery. Mean horizontal deviation decreased from 43.75±10,69 D to 12.83±8.38 D with surgery. CONCLUSION: In neurologically impaired strabismic children, surgery is effective in patients with stable deviations or unstable but high angle deviations. Decision for surgery should be made after a long follow up period.