1. Congenital lid slit congenital lid slit is a narrow lid slit. It is an autosomal dominant disorder. 1.1 Clinical manifestations The left and right and upper and lower lid diameters are significantly smaller than normal. It is often associated with an abnormal medial canthus angle. The small lid fissures are often associated with a series of eyelid and facial developmental abnormalities such as ptosis, reversible canthus, distant medial canthus, lower lid ectropion, low nasal bridge, small eyeballs, small cornea, and supraorbital rim hypoplasia, presenting a face similar to that of Down syndrome. 1.2 Treatment Plastic surgery such as canthoplasty, rhinoplasty, and upper eyelid correction for combined ptosis can be performed in stages. 2. Bilateral eyelashes Bilateral eyelashes are congenital abnormalities of eyelash development. It is dominantly inherited. 2.1 Clinical manifestations Another row of eyelashes occurs behind the normal eyelashes and grows out of the lid gland. The number of lashes is as few as 3 to 5 and as many as 20. They are mostly found in the upper and lower lids of both eyes, but also in the lower lids of both eyes or in one eye. The eyelashes in both rows are thin and short, with little pigmentation, or the same as normal eyelashes. They are regularly arranged, upright or inclined inward. They often cause corneal irritation. Positive staining of the lower half of the cornea is seen under slit lamp. Occasionally, there is a combination of ectropion of the lid margin. 2.2 Treatment The eyelashes can be destroyed by freezing or electrolysis of their follicles, or the margins can be separated under a microscope to expose the follicles of the double row of eyelashes, which are removed together with the eyelashes, and the anterior and posterior lips of the incision are repositioned in pairs. 3. Congenital entropion Congenital entropion occurs mainly in infants and children, more in females than males. It often heals naturally with age. 3.1 Clinical presentation Mostly bilateral, the lid margin of the lower lid near the medial canthus is involuted, causing the eyelashes to fall back toward the eye. Epithelial damage occurs due to irritation of the cornea and is often brought to the attention of parents due to lacrimation and photophobia. Conjunctival congestion, infiltration or thin clouding with positive staining is seen below the cornea. Occasionally, superior entropion is seen. 3.2 Treatment In mild cases, eye ointment is applied to protect the cornea, and in severe cases, surgical correction is required. This style often starts with a wire cutter to perform a full subcutaneous peel of the lower lid followed by a suture entropion correction, using the force of the suture pull 4. Ptosis 4.1 Congenital ptosis (1) Simple ptosis is ptosis caused by congenital abnormal development of the levator muscle, but the nerves distributed in the levator muscle are normal. Surgery is the only treatment and can be performed either by shortening the levator muscle or migrating the superior transverse ligament, or a combination of both in severe cases. The author’s procedure is described as follows: ① Mark the skin incision with gentian violet, usually 3-5 mm from the lid margin. ② Anesthesia: deep infiltration anesthesia of the eyelid and levator muscle and a small infiltration of the conjunctiva in the dome. (③) Separation of the conjunctiva: A traction suture is made near the center of the upper lid margin, the upper lid is turned with an open lid hook, the traction suture is pulled, and the conjunctiva of the upper dome is fully exposed, a 3-5 mm conjunctival incision perpendicular to the lid margin is made in the center, and the conjunctival incision is closed with 1 to 2 stitches after the scissors are inserted into the incision and the conjunctiva of the dome is separated subconsciously on both sides, respectively. ④ Separation of the superior transverse ligament and levator muscle: reach into the angle plate to the superior vaulted conjunctiva. An upper lid skin incision is made according to the design markings, and part of the orbicularis oculi muscle is cut away to expose the lid plate and upper edge of the lid plate. The orbital septum is incised and the fat is cut away. The upper edge of the orbital septal incision and the fat are pulled toward the orbital rim with an open lid hook and a transverse, tough white ligament can be seen behind and below the orbital rim. After separating it from the levator muscle below, the levator muscle continues to be separated deeper, and the levator muscle is cut transversely at the superior margin of the lid. The levator muscle is cut on both sides at the same time, and the levator muscle is freed so that it can be pulled freely without resistance. ⑤ Shortening of the levator muscle and the anterior superior transverse ligament: three pairs of mattress sutures are placed superficially on the lid 1 to 2 mm from the lid margin and are passed over the upper part of the levator muscle and the superior transverse ligament, respectively, and the sutures are ligated and the upper lid position is observed. (6) Suture the upper lid skin incision: suture 6, for the purpose of blepharoplasty, the sutures may be ligated after passing through the upper lip of the incision and then through the broken end of the excised levator muscle and then through the lower lip of the incision. (7) The lower lid retractor is made to protect the cornea from exposure and is fixed to the forehead. (8) Postoperative dressing changes are done every other day and the stitches are removed in 7 days. (2) Supraspinatus dyskinesia complicating ptosis Although the supraspinatus muscle has separated from the levator muscle in embryologically developing humans, these two can still be trapped together in developmental abnormalities and develop supraspinatus dyskinesia complicating ptosis. The author has also encountered cases of bilateral supraspinatus paralysis complicated by true ptosis. After 3 months, depending on the presence or absence of Bell’s phenomenon, a shortening of the levator aponeurosis or an anterior migration of the superior transverse ligament, as appropriate, can be performed. 4.2 Acquired ptosis (1) Myogenic ptosis ① Gradual onset of ptosis due to age, in severe cases the upper lid is often lifted with the fingers or the head is tilted back to see. The cause is a splitting of the tendon membrane of the levator muscle. It can occur in a family of ptosis. Treatment: Same as myogenic ptosis. (2) Traumatic ptosis The ptosis occurs after deep laceration of the upper eyelid, orbital rim fracture, orbital wall fracture, or removal of the eyeball, and falls into this category. (3) Neurogenic ptosis A ptosis that occurs as a partial symptom of Homer’s syndrome and actinic nerve palsy. (4) Mechanical ptosis This type of ptosis occurs when the weight of the upper eyelid increases or scar formation affects the upper eyelid lifting function.