Isolated Rupture of Extraocular Muscles in a Severe Penetrating Trauma – “A Globe Shielded by Muscles”

Traumatic rupture of an extraocular muscle is noted infrequently. The medial and inferior rectus muscles are usually found to be affected. We report an unusual case of superior oblique and medial rectus rupture after a penetrating trauma by the metallic hook. The surgical repair was combined with botulinum toxin injection into the ipsilateral antagonist to prevent consequent contracture, thus also augmenting the orthoptic outcome. At one month follow-up, remarkably good primary position alignment with fine range of extraocular movements was achieved. This case report emphasizes on myriad presentations of ocular trauma and highlights the significance of well-planned surgical management.