A retrospective study of the surgical treatment of patients with excess esotropia at near was conducted. Thirty-one patients conformed to the following criteria: equal vision in each eye, esotropia at near exceeding distant deviation by 15 or more prism diopters, and no prior surgery. Hyperopes greater than or equal to +1.50 spherical equivalent were measured in their full spectacle correction. All patients had an otherwise normal ocular examination and no overt neurological disease. At distance fixation, approximately half of the population had an esotropia greater than 10 delta and the remainder were orthophoric. All demonstrated a near deviation measuring at least 25 delta. Patient age at time of surgery ranged from 18 months to 36 years. All but two patients underwent bilateral medial rectus recessions of 4.5 mm to 7 mm, based on the near deviation. The remaining two patients underwent right medial rectus recessions of 6 mm each. Minimum postoperative follow-up was 4 months. The majority of patients were able to achieve satisfactory alignment. Many could maintain this alignment without spectacles. Two patients developed consecutive exotropia. One of these patients required bilateral lateral rectus recessions to achieve alignment.