Accommodative esotropia is the most common form of all childhood strabismus. Functional and cosmetic outcomes are often good with hyperopic correction. This type of strabismus could be observed in association with other ocular findings which contribute to low vision. This report presents 2 cases of pathologic eyes with low vision and strabismus which completely controlled by hyperopic correction only.

The first case was a 2 y/o child referred for low vision consult. The baby had accommodative esotropia and handheld cycloplegic refraction was +7.00, -1.00*170 (OD) and +7.00, -3.00*170 (OS). On SLE there was 3 mm bilateral central circular corneal opacity and otherwise examination was completely normal. According to corneal opacity penetrating keratoplasty was suggested for her in another centre, to improve vision. The second case was a 3 y/o child with accommodative esotropia and bilateral large inferior iris coloboma on SLE. Cycloplegic refraction was +12.00 and on funduscopy there was clobomatous peripheral retina and foveal pigmentary changes (OU).

Treatment for both cases consisted of full hyperopic correction by spectacles. The first case is now 12 y/o with BCVA of 8/10 in each eye. Recent cornea specialist consult suggested follow up for corneal opacities. The second case now in her twenties, has a BCVA of 4/10 (OU). Both cases are orthoptic with their glasses and have good self-image and social communications.

In conclusion in children with accommodative esotropia, low vision could be due to associated ocular pathologies or uncorrected refractive error. Then cycloplegic refraction and full correction if needed is the first step. Like other forms of accommodative esotropia, refractive correction in such cases could result in good final visual acuity and binocular vision. Surgical correction of ocular pathology may be required later or not. Management should be based on etiology of low vision which has a significant impact on prognosis.