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AIM: To assess the clinical efficacy of sub-tenon anesthesia using a ropivacaine and lidocaine mixture for strabismus surgery. <p>METHODS: Totally 80 patients with horizontal strabismus who underwent local anaesthesia surgery were randomly divided into test group and control group. All cases received either sub-tenon anesthesia or subconjunctival anesthesia with 7.5g/L ropivacaine and 20g/L lidocaine mixtures randomly. Intraoperative and postoperative pain scores and oculocardiac reflex were assessed. <p>RESULTS: All 80 cases were successful completion of the surgery under local anesthesia. According to visual analogue scale(VAS), excellent 12 cases, good 21 cases, fair 6 cases, poor 1 case in test group and excellent 2 cases, good 25 cases, fair 12 cases, poor 1 case in control group. There was significant difference by rank sum test(<i>P</i><0.01). The number of ocular rectus muscle and oculocardiac reflex condition during operation: muscular traction in test group was 74, oculocardiac reflex was 26; in control group it was 76 and 48 respectively. The incidence of oculocardiac reflex between the two groups was significant difference by <i>χ</i>² test(<i>P</i><0.01). Rank sum test were used in oculocardiac reflection grade of two groups, there was no statistically difference(<i>P</i>>0.05).<p>CONCLUSION: Sub-tenon anesthesia using a 7.5g/L ropivacaine and 20g/L lidocaine mixture proves to be an efficient procedure for strabismus surgery, which is worth popularizing and applying.