Purpose : The aim of this study is to present a novel surgical technique in the management of severe blepharoptosis with poor levator function.

Methods : Four patients (five eyes) were included in this study. Mean age of the patients was 15.3 years (range, 3-28 years). Preoperative levator function averaged 3.4± 0.9 mm . All of the patients underwent combined maximum levator resection and septal sling in the ptotic eye.

Results : The follow-up ranged from 4 to 10 months (mean, 8 months).�Preoperative palpebral apertures averaged 4.4± 0.7 mm and postoperative apertures averaged 8.5± 0.4 mm (P<0.001). There was marked improvement in the aperture ( 4.1 mm ). The mean of margin reflex distance-1 (MRD-1) was increased from 0±1 preoperatively to 4.1±0.4 postoperatively (P<0.001). All the patients demonstrated symmetry of the upper eyelid position (less than 1 mm ), good lid crease position, and acceptable cosmetic outcome. All of the patients revealed some degree of lid lag and lagophthalmus. One patient developed exposure keratopathy associated with lagophthalmus which was treated successfully with lubrication.

Conclusion : This preliminary study shows that this new technique may be a useful alternative in the management of severe blepharoptosis associated with poor levator function.