The relationship between prisms and lenses can be an asset in the management of strabismus. Relief from diplopia in incomitant strabismus is challenging and may be complicated by large refractive errors or ill-fitting spectacles. Practical optical techniques include crossing and splitting incorporated prisms, using slab-off lenses or oblique prisms, and combining contact lenses with a spectacle correction or prisms. Spectacle frame selection and fit may induce an ocular deviation or influence an existing one. Selecting an appropriate frame, particularly if prisms will be incorporated, contributes to binocular comfort.