PURPOSE. Identification of risk factors for accommodative esotropia may help to determine which children with hyperopia may benefit from early spectacle correction or preventive therapy. METHODS. Participants in the family history study were 95 consecutive patients, aged 18 to 60 months, with accommodative esotropia. Participants in the binocular sensory function study were a subgroup of 41 children enrolled in the family history study within 1 month of onset, while the esodeviation was still intermittent. Participants in the hypermetropia study were 345 consecutive patients, ages 12 months to 8 years, with refractive error of + 2.00 D or greater and no esodeviation before age 12 months. RESULTS. In the family history study, 23% of children with accommodative esotropia had an affected first- degree relative, and 91% had at least one affected relative. In the binocular sensory function study, random- dot stereoacuity was abnormal in41% of children, whereas an abnormal motion VEP, Worth4- dot, or positive4- PD base- out prism responses were present in4% or less of the children. In the hypermetropia study, patients with a mean spherical equivalent of<+ 3.00 D and significant anisometropia had a 7.8- fold increased risk for accommodative esotropia over nonanisometropic patients. CONCLUSIONS. A positive family history, subnormal random- dot stereopsis, and hypermetropic anisometropia each pose a significant risk for the development of accommodative esotropia. Assessment of these risk factors in conjunction with refractive screening should help to identify those children who are most likely to benefit from early spectacle correction or preventive treatment. PURPOSE. Identification of risk factors for accommodative esotropia may help to determine which children with hyperopia may benefit from early spectacle correction or preventive therapy. METHODS. Participants in the family history study were 95 consecutive patients, aged 18 to 60 months, with accommodative esotropia. Participants in the binocular sensory function study were a subgroup of 41 children enrolled in the family history study within 1 month of onset, while the esodeviation was still intermittent. Participants in the hypermetropia study were 345 consecutive patients, ages 12 months to 8 years, with refractive error of + 2.00 D or greater and no esodeviation before age 12 months. RESULTS. In the family history study, 23% of children with accommodative esotropia had an affected first- degree relative, and 91% had at least one affected relative. In the binocular sensory function study, random-dot stereoacuity was abnormal in 41% of children, could an abnormal motion VEP, Worth4 - dot, or positive 4-PD base-out prism responses were present in 4% or less of the children. In the hypermetropia study, patients with a mean spherical equivalent of <+ 3.00 D and significant anisometropia had a 7.8- fold increased risk for accommodative esotropia over nonanisometropic patients. CONCLUSIONS. A positive family history, subnormal random-dot stereopsis, and hypermetropic anisometropia each pose a significant risk for the development of accommodative esotropia. Assessment of these risk factors in conjunction with refractive screening should help identify that children who are most likely to benefit from early spectacle correction or preventive treatment.