Background/aims-Microtropia is believed to be a static condition, in which accepted achievable levels of vision are those of 6/12-6/9 maximum, with the inability to achieve "normal" levels of stereopsis. The aim of this paper was to present the results of treatment of 30 consecutively presenting primary microtropes, and assess their outcomes using a more active treatment strategy than that conventionally used. Methods-Visual acuity, stereoacuity, fixation, and the presence of a central suppression scotoma were assessed in all patients before, during, and after treatment, which comprised wearing maximum refractive correction, and an occlusion strategy aiming for equal visual acuity. Results-Equal visual acuity of 6/5 Snellen was achieved in 43% of the 30 patients, while 87% achieved 6/9 Snellen or better visual acuity in the microtropic eye. Stereoacuity of better than 60" of arc was attained in 37%, and foveal fixation on visuscopy in 55%. The treatment outcome was not aVected by the patient's age, initial visual acuity, or the amount of anisometropia. A change in the patient's diagnosis was noted in 50%, with nine patients recovering completely. Conclusions-The results show that microtropia is not static. Equal 6/5 vision is attainable, as is high grade stereoacuity. The pattern of fixation may change during treatment and elimination of the microtropia is possible in some cases. There is a requirement for management protocols to be changed in order to treat this condition more eVectively. (Br J Ophthalmol 1998;82:219-224) Small angled squint with characteristics consistent with the term microtropia has been recognised for over 40 years.1-3 Parks and Eustis introduced the term monofixational phoria 4 which they later revised to monofixation syndrome, 5 to describe an absence of bifoveal fusion with maintenance of normal retinal correspondence (NRC) associated with an enlarged Panum's fusional area. Microtropia has been the subject of debate since Lang 6 coined the term to describe a small angled strabismus with anomalous retinal correspondence (ARC), normal fusional amplitudes, and reduced stereopsis. Helveston and von Noorden 7 initially reserved this term for cases in which the uniocular angle of eccentric fixation and the angle of anomaly were coincident, and therefore no movement was evident on the cover-uncover test. However, both sets of authors have now adopted the term "microtropia" to encompass both positive and negative cover-uncover test findings.