Double extraocular muscle avulsion following injury by goat's horn

Introduction: Trauma to extraocular muscle without globe perforation is rare. This case report describes the clinical features and principles of repair of the simultaneous injury to two extraocular muscles sustained from a goat's horn. Methods: Case records of the 36-year-old man who suffered trauma to his left eye were reviewed. Results: Examination revealed diplopia, hypotropia of the left eye, and a lacerated superior conjunctiva through which a muscle tendon prolapsed. Magnetic resonance imaging (MRI) of the orbit indicated discontinuity and fuzziness of the left superior rectus muscle (SR). Surgical exploration showed that the prolapsed tendon belonged to the superior oblique muscle (SO). Avulsion of SR was also noted 14 mm from its insertion. The proximal end of SR was anastomosed with the distal segment. The proximal end of the SO could not be traced. Postoperatively, the elevation improved marginally and there was a small hypotropia. His diplopia was managed with prisms. Discussion:The goat's horn acted like a hook and avulsed two contiguous muscles from orbit in a posterior to anterior direction. The hypertropia due to SO avulsion was compensated partly by the hypotropia due to the concurrent damage to the SR. Immediate surgical intervention resulted in a good alignment.