OBJECTIVETo evaluate the clinical result of the frontalis muscle fascial flap passing through the pulley of orbital septum for correction of severe blepharoptosis.

METHODS57 eyes in 52 cases with congenital severe blepharoptosis were treated in recent two years. After the frontalis muscle fascial flap was prepared beneath the orbicularis oculi muscle, the pulley was created by two parallel horizontal incision on the orbital septum at the upper orbital rim and 1 cm under the upper rim. The frontalis muscle fascial flap was then pulled down behind the pulley and out to be attached to the upper margin of tarsal plate.

RESULTSThe following-up period was 3-6 months. Satisfactory cosmetic result was achieved in 52 eyes. Three eyes had ptosis relapse and 2 eyes had unnatural contour of the palpebral margin which required another corrective operation. No other complication was observed.

CONCLUSIONSThe pulley created by the orbital septum makes the traction lines of the frontalis muscle fascial flap in a similar direction as the natural movement of levator muscle. So both the postoperative static and dynamic appearance of the upper lid is more natural. The technique is very practicable in correction of blepharoptosis.