This study explored the characteristics and outcomes of children with esotropia and ventriculo-peritoneal (VP) shunt placement due to hydrocephalus. The authors conducted a retrospective study of 16 patients (nine female, seven male) aged three months to 5.6 years (mean 17 months). 93.8% had developmental delay and 56.3% were premature. The average age at onset of hydrocephalus was 3.8 months (0-19 months) and average age of first shunt was 3.9 months (0-20 months). A total of 62.5% had congenital esotropia and 37.5% had acquired esotropia (four with accommodative esotropia, one with non-accommodative esotropia and one with cyclic esotropia). A total of 68.8% needed glasses – five were myopia and six hypermetropic. Fifty percent were amblyopia and 31.3% had optic atrophy. The authors report a higher incidence of congenital esotropia and myopic refractive error in these children compared with the general population.