We treated 84 patients with a partially refractive accommodative esotropia with bifocals. Twelve patients were able to fuse without bifocals at the end of therapy; in 19, the bifocal power could be reduced and further improvement can be expected in the future. Thirty-nine remained dependent on bifocals; and in 14, fusion had deteriorated in spite of therapy. Patients with a high AC/A ratio and those receiving supportive orthoptic treatment seemed to fare best with bifocals. In those with a low AC/A ratio, fusion tended to deteriorate because of a slowly increasing esodeviation at near fixation.