Alignment. Accommodative esotropia is treated initially with glasses. The glasses may not improve visual acuity. They are used so the child does not have to make the accommodative effort; the eyes may not "turn in" and the child can use the eyes together, binocularly. If the eyes are aligned with spectacle correction, surgery may never be required. However, if the eyes are not aligned with glasses and/or bifocals, or if the child cannot be weaned from bifocals as he or she grows, then surgery may be indicated. We all lose our ability to accommodate for near tasks as time goes by-the loss of accommodative effort over time is of benefit to children with accommodative esotropia, because they may outgrow the need for glasses and avoid muscle surgery.