Experience in the surgical correction of congenital ptosis in 203 children operated on at The Hospital for Sick Children, Toronto, demonstrated that because of the different types and complicated nature of ptosis the choice of operation in each case is most important. Occasionally ptosis is associated with other anomalies such as blepharophimosis, epicanthus, and the jawwinking syndrome, which further complicate its repair. Although the results in complicated cases are not perfect, these children should be given the benefit of surgery, since almost all can be greatly improved. The best time for surgery is after three years of age but before the child starts school. If adequate levator action is present, shortening this muscle is the operation of choice. If levator function is poor, the lid is elevated by the frontalis muscle and fascia lata. Achievement of symmetry in the position of the lid and width of the palpebral fissure is the key to real success in ptosis surgery.
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