Objective To investigate the effect of levator palpebrae superioris shortening combined with partial tarsus resection on palpebral ffssure height recovery rate and binocular symmetry in patients with moderate to severe ptosis. Methods A total of 60 patients with moderate to severe ptosis admitted to Ningbo Haishu Ximei Medical Beauty Clinic from January 2022 to January 2025 were selected, and they were divided into the control group and the observation group according to different surgical methods, with 30 patients in each group. The control group received simple levator palpebrae superioris shortening, and the observation group received levator palpebrae superioris shortening combined with partial tarsus resection. The palpebral ffssure height recovery rate, binocular symmetry, ocular surface function indicators and aesthetic satisfaction were compared between the two groups. Results The palpebral ffssure height (PFH) and palpebral ffssure height recovery rate of the observation group were higher than those of the control group (P<0.05). The binocular PFH difference of the observation group was lower than that of the control group, and the binocular symmetry index (BSI) was higher than that of the control group (P<0.05). At 3 months after operation, the tear fflm break-up time (TBUT) and Schirmer Ⅰtest (SⅠt) of the observation group were higher than those of the control group, and the corneal ffuorescein staining (CFS) score was lower than that of the control group (P<0.05). The aesthetic satisfaction of the observation group (93.33%) was higher than that of the control group (70.00%) (P<0.05). Conclusion Levator palpebrae superioris shortening combined with partial tarsus resection can improve the palpebral ffssure height recovery rate of patients with moderate to severe ptosis, enhance binocular symmetry, protect ocular surface function, and achieve high aesthetic satisfaction, which has high clinical application value.