Abstract
A re-examination of the etiology and natural history of accommodative esotropia has shown several departures from traditional concepts. Deterioration to non-accommodative esotropia was not confined to cases with an abnormally high distance/near relationship. Increases in hypermetropia were not more rapid nor more prominent than in a non-strabismic population of the same age range. Accommodative esotropia is not only a separate strabismus entity, but is found frequently as a recognized or hidden component of congenital esotropia, as well as of other motility anomalies. The implications of these observations are discussed.

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