The purpose of this study was to evaluate the long-term outcomes of childhood ptosis surgery in a population-based cohort. The authors assessed reoperation rates, amblyopia, risk of lag, dry eye and other complications. This was a retrospective review of 47 patients (28 males and 19 females). Right lid surgery was undertaken in 15, left lid surgery in 28 and bilateral in four: 51 lids of 47 patients. Median age at first surgery was 5.6 (1.5-17.8 years). There was a median time of 1.1 years (0.03-7.8) between first and second surgery and six years (0.3-6.1) between second and third surgeries. Median follow-up was 3.3 years (0.01-22.9). Congenital ptosis was present in 41 cases plus one case each of blepharochalesis, blepharophimosis, Crouzon syndrome, Noonan syndrome, congenital third nerve palsy and acquired ptosis. First surgical procedures included levator research (n=37), frontalis suspension (n=8), Mueller resection or Fasanella servat (n=6). Reoperations at less than two years follow-up was needed for two patients with levator aponeurosis advancement. Reoperations at greater than two years follow-up was needed for 14 lids. Complications included lid lag for 19 cases and dry eye for three cases. Most reoperations were for residual ptosis occurring in one third of cases and postoperative lid lag in nearly half of cases.