This paper reviews the long-term follow-up of esotropia with a high AC/A ratio defined as an increase of 20 delta or more of the esotropia at near compared with distance with the full optical correction of any refractive error in place. Ninety-nine patients were studied for an average follow-up of eight years. Eighty-six achieved fusion but only five achieved central fusion. Forty-five were treated with bifocals. No significant difference in the sensory results were recorded in those patients wearing bifocals compared with those who did not wear bifocals. No patient had miotic therapy for more than a few months. The suppression characteristic of this condition is reviewed.