Objective: To study health-related quality of life (HRQOL) in adult strabismus patients with successful corrective surgery outcomes, and to evaluate the factors associated with the status of post-operative HRQOL. Methods: In this retrospective case-control study, 92 adults who underwent corrective surgery during January to December 2011 and were followed for at least 1 year from Eye Hospital, Wenzhou Medical University were recruited; HRQOL was evaluated before and after surgery using the Chinese version of the Adult Strabismus 20 (CAS-20). Demographics and clinical characteristics were recorded. Eighty-nine cases of age-matched normal people without a history of strabismus were recruited from the general population as the control group. A Wilcoxon signed-rank test, independent t test, paired t test, and ANOVA were used to evaluate the difference in the CAS-20 scores. A multivariate analysis ofvariance was used to study the relationship between postoperative outcomes and demographics based on CAS-20 scores. Results: The CAS-20 scores of the 92 patients improved significantly after surgery in the psychosocial subscale (Z=3.25, P=0.001), function subscale (Z=3.19, P=0.001) and total scale (Z=3.60, P=0.001). Subjects who had better recovery of stereo function (F=4.33, P=0.016) and fusion function (Z=2.60, P=0.009) had better HRQOL than those who did not recover. HRQOL was better in the 68 subjects who did not believe there was a deviation than those 24 cases who believed there was still a deviation (Z=3.69, P<0.001). Postoperative HRQOL was also worse (Z=11.23, P<0.001) in patients than in the normal controls, with approximately 32% of subjects having scores within the normal threshold. The belief that there was no ocular deviation was the significant factor associated with postoperative HRQOL status. Conclusions: HRQOL improved in adults with a successful surgical outcome but was still worse than the general population when evaluated by CAS-20. Subjects who recovered binocular vision had better HRQOL. A belief that there was good alignment was the main factor that correlated with better postoperative HRQOL status.