Objective To investigate the safety and effectivity of posterior scleral reinforcement surgery combined with strabismus surgery in treating pathological myopia with concomitant exotropia. Methods Thirty-two cases of pathological myopia and concomitant exotropia were analyzed retrospectively. Eighteen cases in a combined-surgery group underwent posterior scleral reinforcement for a variant sclera combined with strabismus surgery (lateral rectus recession alone or combined with medial rectus excision); 14 cases in a two-stage operation group underwent posterior scleral reinforcement and strabismus surgery at different time. The therapeutic effects of the procedures were observed and compared. All cases were followed for 12 to 30 months. Data were analyzed with chi-square test or fisher exact probabilities. Results Eighty-two percent eyes attained stable best corrected visual acuity at 3 months postoperatively (improved or unchanged) in the combined-surgery group, and the same in the two-stage operation group. The difference was not statistically significant.Improvement and recovery of binocular vision: 4 cases in the combined-surgery group and 1 case in the two-stage operation group. The difference was not statistically significant. Eye position: 83％ attained satisfactory cosmetic result (primary eye position was within ±5° or prism angle was within ±10△) in the combined-surgery group, and 86％ in the two-stage operation group. The difference was not statistically significant. Stable refractive error (change≤0.5 D per year): 75％ in the combined-surgery group, and 73％ in the two-stage operation group. The difference was not statistically significant.Ocular axis stability (change≤0.3 mm per year): 75％ in the combined-surgery group, and 77％ in the two-stage operation group. The difference was not statistically significant. Complications: there were no complications such as retinal detachment, anterior segment ischemia, etc. However, different degrees of conjunctival aponeurosis edema and diplopia were common. Conclusi