An understanding of accommodation, convergence, hypermetropia and their relationship to one another is crucial to the appropriate management of accommodative esotropia. Practically, however, the most important issue is how to manage the hypermetropic correction. Donders first described accommodative esotropia in the 19th century,1 so why then, almost 150 years later, does the question even arise as to the best way of correcting the hypermetropic refractive error associated with an accommodative esotropia?

Perusal of the literature search engines gives part of the answer. There is a paucity of prospective studies2 in this area, and as previously suggested,3 those studies that have been published are difficult to compare because of a lack of detail as to how the initial hypermetropia was corrected. Details such as how cycloplegia was attained are important. It is worth remembering that cyclopentolate is far less effective at causing cycloplegia than atropine,4 so that “full” …