A Systematic Review on Conjunctival Closure Techniques in Strabismus Surgery: Current Evidence and Clinical Practice

Strabismus, or eye misalignment, is a common condition with significant functional and psychosocial consequences. Conventional strabismus surgery typically employs absorbable sutures for conjunctival closure; however, this approach may prolong operative time and contribute to postoperative irritation and inflammation. This systematic review synthesised evidence comparing traditional suturing with alternative sutureless techniques, including fibrin glue and minimally invasive approaches, to determine their impact on surgical efficiency, patient comfort, and safety. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search identified 13 studies published between 2010 and 2025, encompassing seven randomised controlled trials (RCTs) and six comparative observational studies, with a total of 765 eyes meeting the inclusion criteria. Across the included studies, sutureless closure methods were consistently associated with improved early postoperative outcomes such as reduced inflammation, redness, chemosis, and foreign-body sensation (FBS), contributing to enhanced patient comfort. Operative efficiency was also superior in the sutureless groups, with fibrin glue use significantly reducing surgical time. Both sutured and sutureless techniques achieved comparable long-term alignment success and safety outcomes. The evidence, therefore, suggests that sutureless methods, particularly fibrin glue closure, may provide a more efficient and comfortable alternative to traditional suturing without compromising efficacy. Nevertheless, practical barriers, including the cost of fibrin glue and the learning curve associated with minimally invasive approaches, continue to limit widespread implementation. High-quality, multicenter randomised trials with standardised long-term follow-up are warranted to further validate these findings and establish best practice in contemporary strabismus surgery.