The profession of orthoptist has existed for approximately 100 years. Mary Maddox, credited as the first orthoptist, commenced orthoptic practice in London in the early 1920s. In 1928 the first hospital based orthoptic clinic opened in the Royal Westminster Hospital in London. Since its beginning, the profession has undergone some significant evolutionary changes. Along the way many early orthoptic treatment practices have been abandoned and forgotten. Here, I look back at how orthoptics was practiced in the past and the methods and tools used in the early years of orthoptic practice. I will explore how and why orthoptic practices changed over time, linking it to the current state of practice and potential for the future development of the profession.