The treatment of accommodative esotropia requires a thorough evaluation at first presentation to elucidate all factors involved. The degree of hypermetropia, character of the esodeviation (i.e., intermittent or constant), presence or absence of amblyopia, and the AC/A ratio are all important in the initial management of these patients. In addition, the binocular status can be of prognostic value. Close follow-up is needed to ensure maintenance of binocularity and appropriate early intervention to modify the course before bifixation is lost.