Accommodative esotropia is defined as a convergent deviation of the eyes associated with activation of the accommodative reflex and is one of the most common forms of strabismus. Refractive accommodative esotropia could be due to uncorrected hyperopia. The concordance of strabismic phenotypes was reported in monozygotic and multizygotic twins rarely. This paper presents 3 cases of twins with accommodative esotropia which completely resolved by hyperopic correction. In one pair of cases there was “mirror image” esotropia.

The first was a pair of 5 y/o identical male twin with “mirror image” accommodative esotropia. The twin 1 had esotropia in the right eye, while the twin 2 was affected by the left eye. The second was a pair of 4 y/o identical female twin with esotropia both in left eye. The third was a pair of 12 months old female twin with accommodative esotropia both in left eye, like second pair. Slit lamp and funduscopic examination was normal in all twins.

Treatment consisted of full cycloplegic refraction of all twins which showed simple high hyperopia. Then esotropia was fully corrected by glasses prescription in all twins. The importance of full-time wear of spectacle correction and possibility of increasing esodeviation by initially after the correction was discussed with the parents.

In conclusion concordance of accommodative esotropia in twins suggests the strong genetic background for this type of strabismus. Also in these cases refractive correction could result in good final visual acuity and binocular vision and surgery must be postponed. Surgical correction may be required when a patient fails to regain fusion with glasses. However, in such cases latent un-corrected hyperopia must be ruled out before proceeding with surgery.