Sustained outcomes over a three-year horizon after refined conjoint fascial sheath suspension in severe congenital ptosis

Purpose: Conjoint fascial sheath suspension is an effective treatment for severe congenital ptosis, but its application in young children remains debated. This study refined the technique and compared outcomes between children and adults to clarify the optimal age for its use. Methods: Patients with severe congenital ptosis and poor levator function (≤4 mm) were grouped by age: preschool (3–6 years), school-aged (7–17 years), and adult (>18 years). All underwent refined conjoint fascial sheath suspension surgery and were followed for 3 years. Outcomes were compared across groups. Levator aponeurosis complex samples were analyzed histologically to evaluate collagen fiber, smooth muscle, and skeletal muscle content and assess developmental differences between children and adults. Results: Data were collected from 39 patients (50 eyes): 14 (18 eyes) in the preschool group, 15 (20 eyes) in the school-aged group, and 10 (12 eyes) in the adult group. All groups showed significant improvements in palpebral fissure height and margin reflex distance 1 ( P <0.05). No significant intergroup differences were observed in palpebral fissure height change, correction rate, recurrence rate, or scleral exposure during follow-up (P>0.05). Smooth muscle, collagen fiber, and skeletal muscle content in the levator complex did not vary by age ( P >0.05). No complications, including trichiasis or conjunctival prolapse, occurred. Corneal fluorescein staining remained ≤1 in all patients, who also reported subjective postoperative benefits. Conclusion: Refined conjoint fascial sheath suspension provided effective and durable correction of severe congenital ptosis in children aged 3–17 years, with three-year outcomes comparable to those in adults.