One hundred twenty-seven medical records of patients with accommodative esotropia met our inclusion criteria and were analyzed. All included patients were within 10 prism diopters of orthophoria and had stereopsis and other binocular sensory test results recorded at their latest visit. Bifixation, defined as stereopsis of 50 arc seconds or better, was present in 31 patients (24%) with an average follow up of 89 months. Monofixation (peripheral fusion) was present in the remaining 96 patients (76%) with an average follow up of 84 months. Patients with bifixation were less likely to have presented with constant esotropia (19% vs 39% [P = .04]) and were more likely to be aligned within 8 delta of orthophoria in their first glasses (84% vs 21% [P < .0001]). No patient with bifixation had constant esotropia longer than 4 months. In addition, patients with bifixation were less likely to have worn bifocals (39% vs 59% [P = .09]), or undergone esotropia surgery (23% vs 62% [P < .0001]). These data suggest that maintenance of bifixation is possible in accommodative esotropia if the eyes are straightened before or shortly after the esodeviation becomes constant. With this early therapy, amblyopia and deterioration of ocular alignment are also less likely.