Esotropia is the most common form of strabismus seen in clinic. Accommodation is known to be an important precipitating factor, and its management is usually not complex. In this paper, I have reviewed a dozen circumstances in which the presentation was complicated. For some patients, the cause of fleeting symptoms was elusive and had to be determined through careful sensory and motor testing. In others, the presentation was indicative of serious underlying pathology that warranted further investigation. Lastly, restrictive conditions may be erroneously thought to be neurological, and some of these are also discussed. The patients presented include the following problems: fixation switch diplopia, consecutive esotropia unmasking superior oblique palsy, over-corrected myopia, acute nonaccommodative esotropia, comitant esotropia with underlying cerebellar tumor, sixth nerve palsy due to pontine tumor or cavernous pathology, and thyroid strabismus mimicking sixth nerve palsy.