Purpose: To measure palpebral fissure morphology in patients with severe congenital blepharoptosis. Methods: The palpebral fissure shape of 20 patients (30 eyes) with severe congenital blepharoptosis (levator excursion ≤4 mm) was quantified with digital image processing in a cross-sectional design. Several variables related to the morphology of the palpebral fissure were measured: (a) upper and lower eyelid curvature, (b) palpebral fissure angle, and (c) position of the upper maximum and lower minimum eyelid contour. Results: Patients with severe congenital blepharoptosis often show a moderate degree of antimongoloid palpebral fissure orientation and eyelid drooping that is greater temporally than nasally. Conclusions: Contour adjustment in severe congenital blepharoptosis surgery is better when it is not centered on the midline, but rather has a slight lateral displacement.
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