PURPOSE. In this prospective cross-sectional observational study, the distribution of organic pathologies in patients initially presenting with strabismus was evaluated. METHODS. Thirty-one of 243 patients examined between May 1997 and May 1998 had strabismus due to organic causes and 28 patients had posterior segment abnormalities. RESULTS. Toxoplasma chorioretinitis, morning glory anomaly, toxocara retinopathy, retinopathy of prematurity and Coats' disease were the most common diagnoses. Eighteen patients (58%) had esotropia and 13 (42%) had exotropia. The mean age of onset of deviation was significantly lower in the esotropic patients. There was no correlation between the degree of visual impairment and direction of deviation. CONCLUSIONS. Our study strongly underlines the importance of fundus examination in each strabismic patient.