To investigate risk factors of esotropia, anisometropia and amblyopia and compare the clinical features in hypermetropic children according to the amount of hyperopia.

This study included 377 patients with cycloplegic refractive error of +1 D or greater at first visit. Patients were divided into 3 groups according to the refractive error. Odds ratios were calculated to evaluate the association of clinical risk factors with esotropia, anisometropi and amblyopia. Clinical features were compared between surgical and non-surgical groups.

Hyperopia <+6 D showed greater odds of anisometropia. Hyperopia of ≥+6 D showed greater odds of bilateral amblyopia to 14.796 and hyperopia of <+6 D increased odds of unilateral amblyopia. Moderate hyperopia (≥3 D to <6 D) increased the odds ratio for development of esotropia to 1.862. Patients with anisometropia ≥2 D had a 5.386 times increased odds of esotropia and those younger than 2 years had a 5.578 times increased odds of esotropia. Surgical groups showed lower amount of hyperopia than non-surgical groups. Hyperopia <+3 D had higher prevalence of esotropic surgery (50.72%).

Moderate hyperopia and anisometroia ≥2 D increased the risk for development of esotropia. Greater prevalence of bilateral amblyopia and lower prevalence of esotrpia was found predominantly in groups with higher amount of hyperopia. We recommend optical correction at an early age with higher hyperopia and surgical treatment should be considered for esotropic children with lower hyperopia.