Our aim was to evaluate the factors that result in decompensation of accommodative esotropia

This retrospective study was done in 200 cases of accommodative esotropia that decompensated after responding to spectacle during 1998-2008 .Patients data such as age, sex, cycloplegic refraction, latent hyperopia , amblyopia, anisometropia,vertical muscle dysfunction, DVD,AC/A ratio ,amount of deviation & duration of follow-up extracted & studied with spss soft ware. Decompensation was defined as distant esotropia greater than 10 prism diopter(PD) after at least 6week of stable alignment of deviation (less than 8 PD).

Total cases were 200 subjects that equally were male & female. Average age was 4year (1-8y).average cycloplegic refraction was +4 diopter (2-10). Average follow-up was 48m (6-90). Decompensation developed in 20% of cases. The most important factors that result in decompensation were latent hypertropia (25%=10 cases), uncontrolled amblyopia(20%=8 cases),anisometropia(20%=8cases),vertical muscle dysfunction(15%=6cases),DVD(10%=4 cases) & unknown(5%=2 cases).Decompensation occurred 10% in first year,20% in second year,30% in third year & remainder after third year.

This study showed that the most common factor results in decompensation was under corrected or latent hyperopia.Therefore, the full correct cycloplegic refraction was the main stain for accommodative esotropia.