To investigate the clinical features of refractive accommodative esotropia with hyperopic anisometropia.

Retrospective chart review was performed for 71 patients with refractive accommodative esotropia and hyperopic anisometropia. Patients were divided into isometropia and anisometropia groups, as well as disappeared anisometropia and maintained anisometropia groups. Clinical features such as amblyopia, stereopsis, decompensation, and cessation of spectacle use were reviewed.

Anisometropia was found in 14 patients (19.7%). Amblyopia was detected in 35% of the patients in the isometropia group and 67% of the patients in the anisometropia group on the first visit ( p = 0.048), but improved to 14% in the isometropia group and 21% in the anisometropia group on the final visit. Good stereopsis was reported in 28% of the patients in the isometropia group and 21% of the patients in the anisometropia group on the first visit, and improved to 67% in the isometropia group and 79% in the anisometropia group on the final visit. There were no differences of prevalence of decompensation and cessation of spectacle use between the 2 groups. Cases with disappeared anisometropia on the final visit were observed in 42.9% of the patients. Disappearance of anisometropia was not related with amblyopia, stereopsis, decompensation, and cessation of spectacle use.

Although refractive accommodative esotropia accompanied by anisometropia has a greater chance to show amblyopia on the initial visit, good prognosis can be expected when the patients are carefully managed with hyperopic correction and occlusion therapy.