This study aimed to evaluate hyperopic evolution patterns in children with early diagnosis (before three years) and treatment. This was a retrospective study of 78 eyes of 39 children. Forty-nine percent were males and mean follow-up was 130 months (72-193). At first examination, median refraction was 4.4D (IQR 1.8D); 36% of eyes had spherical equivalents of ≥5.5D. Partially accommodative esotropia was present in 23%, accommodative esotropia in 26% and ortho in 51%. Four had unilateral amblyopia. At follow-up, there was no reduction in hyperopia magnitude or numbers with strabismus. A difference was found in the evolution of refraction for children with partially accommodation and accommodative esotropia but this was not clinically significant. Amblyopia improved so early detection of high refractive errors may prevent long-term visual issues.