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. 2022 Sep 23;261(3):879–889. doi: 10.1007/s00417-022-05830-3

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 3 — Effects and diagram of surgical management, and MRI in Subject 15. A Before ptosis and strabismus surgery, the individual was presented with severe ptosis, fixed infraduction, and esotropia. B After surgery, she got an excellent prognosis with bilateral PFH improvement and microtropia. C MRI showed slight atrophy of bilateral LR, compared to MR. D Diagram of modified levator muscle complex suspension. MRI, magnetic resonance imaging; SR, superior rectus. LR, lateral rectus. MR, medial rectus. IR, inferior rectus. SO, superior oblique. ON, optic nerve. CFS, combined fascia sheath