The congenital eyelid tetrad (CET) comprises epicanthal folds, telecanthus, ptosis, and blepharophimosis. The natural history of CET is that with time the epicanthal folds disappear and the telecanthus becomes insignificant, but the ptosis and the blepharophimosis remain functional and cosmetic problems. Surgical correction of the ptosis and the blepharophimosis should be performed early in the patient's life, but surgical correction of the telecanthus and epicanthal folds should be deferred until growth is complete when such surgery may not be necessary.