Contradicting earlier doctrine, several studies have indicated that hypermetropia in childhood increases over the first seven years of life, and decreases thereafter. No clear consensus exists as to these characteristics in patients with accommodative esodeviation. In 68 subjects (136 eyes), the mean annual change in hypermetropia up to the seventh birthday was an increase of +0.19 +/- 0.36 D. Subjects whose accommodative deviation deteriorated showed changes similar in magnitude. The corresponding mean annual change in a previously reported age-matched series unselected for strabismus was +0.28 D. Hypermetropia in accommodative esodeviation showed a mean annual decrease between ages 7 and 13 years of -0.18 +/- 0.25 D. The corresponding finding in the general childhood population was -0.22 D. While clinically important individual departures from these results do occur, an accelerated rate of increase in hypermetropia is not characteristic of most cases of either controlled or of deteriorated accommodative esodeviation.