Purpose To examine the characteristics of blepharoptosis and the success of surgical intervention in a large group of children presenting to a specialist at paediatric ophthalmology center. Methods Ten-year retrospective case notes review of patients presenting to the Birmingham Children's Hospital for blepharoptosis surgery. Resultant database was interrogated for aetiology of ptosis; severity; surgical correction; outcome; complications and need for reoperation. Results One hundred and fifty five children (186 eyes) underwent blepharoptosis surgery. Hundred and ten patients (71%) were treated with a levator resection procedure, 28 (18%) underwent a brow suspension using Mersilene mesh, 15 (10%) with Fasanella Servat procedure and 2 (1%) with La Mange procedure. The mean post-operative follow-up was 30.82 months with 84 children completing a minimum of 12 months follow-up. Overall, 70.97% lids were successfully corrected with a single operation. In 9.14% lids, the results were fair but no further surgery was carried out. Reoperation was required in 19.89% of lids with the mean time to second surgery being 32.69 months. Amblyopia was found in 26.45% (41 children); in 3 patients, their amblyopia became manifest after the ptosis surgery. A concomitant squint was present in 14.19%, and 18.70% had a significant refractive error requiring spectacles prescription, with anisometropia present in more than 72% of these patients. Conclusions Early referral to an ophthalmologist is necessary even though surgical correction may be delayed. Children with congenital ptosis need to be monitored for amblyopia both pre-and post-operatively, as the incidence of strabismus and refractive errors is much higher than the general population and these may develop even after ptosis surgery.

We present the case of a 9-year-old boy with megalocornea and juvenile cataracts. Bilateral lens aspiration and acrylic intraocular lens (IOL) implantation were performed under general anesthesia. After the surgery, both IOLs gradually decentered. Posterior capsule opacification was a further complication, necessitating bilateral neodymium:YAG (Nd:YAG) capsulotomy under local anesthesia. Five years after the Nd:YAG capsulotomy, the decentered IOLs remained in the same position and the vision remained stable with glasses. Cataract extraction in megalocornea is difficult, and complications are frequent. The type of IOL, IOL size, and need for surgery should be carefully considered.

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Tarsal lower eyelid ectropion can be surgically challenging to correct via the transconjunctival plication or subciliary reattachment of retractors. This method is simple to use, resulting in an excellent outcome with no tissue dissection. This technique is easy to learn and implement for oculoplastic surgeons at all levels of experience.