Objective To explore the effect of fascial sheath suspension combined with levator palpebrae superioris shortening in the correction of congenital severe ptosis and its impact on patients' ocular surface function. Methods A total of 64 patients with congenital severe ptosis admitted to our hospital from January to July 2024 were selected as the research subjects, and they were divided into group A and group B by the random number table method, with 32 patients in each group. Group A was treated with levator palpebrae superioris shortening, and group B was treated with fascial sheath suspension combined with levator palpebrae superioris shortening. The correction effect, ocular surface function, treatment satisfaction and complications were compared between the two groups. Results The excellent and good rate of correction in group B was 93.75%, which was higher than 75.00% in group A (P <0.05). After treatment, the SIt, BUT and FL in group B were lower than those in group A (P <0.05). The treatment satisfaction with appearance at primary gaze and appearance during movement in group B was higher than that in group A (P <0.05). The incidence of complications in group B was 9.38%, which was lower than 31.25% in group A (P <0.05). Conclusion Fascial sheath suspension combined with levator palpebrae superioris shortening can enhance the correction effect on patients with congenital severe ptosis, improve their ocular surface function, with high patient satisfaction and few complications, which is worthy of clinical application.