“…Surgical treatment for more severe cases that did not respond to conservative treatment include sub-conjunctival injection of hyaluronic acid [ 4 ], [ 8 ], [ 13 ], tarsorraphy [ 2 ], [ 3 ], [ 6 ], [ 7 ] tarsorraphy with excision of redundant conjunctiva [ 5 ], [ 7 ], fornix suture [ 3 ], [ 13 ], full-thickness skin graft [ 1 ], [ 2 ], [ 5 ], [ 11 ], full-thickness horizontal lid shortening [ 2 ], [ 6 ], and attachment of the orbital septum to the levator aponeurosis [ 2 ]. Most cases of congenital eversion of the eyelids without Down’s syndrome responded to patching or taping of the eyelids and the use of ointments [ 3 ], [ 6 ], [ 7 ], [ 11 ], [ 13 ], however surgical intervention may be necessary in patients with Down’s syndrome [ 6 ], [ 12 ], [ 14 ]. In our cases, the subconjunctival hyaluronic acid injection was not available at the moment and it was not likely to be effective due the lack of conjunctival chemosis.…”