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Coat Hanger Trauma: A novel presentation of IR transection Saurabh Jain1, Radhika Rampat1, Ankur Gupta1 ¹ Department of Ophthalmology, Royal Free Hospital, London, UK Correspondence: [email protected] History: A 30-year-old Caucasian man suffered a traumatic Presentation complete inferior rectus (IR) transection resulting in a right hypertropia. The injury was secondary to a coat hanger stuck in a bed frame catching his right eye whilst bending down, which the patient then immediately pulled out. Clinical findings: On presentation there was constant vertical diplopia with a 20 dioptre right hypertropia in primary gaze which increased to 45 dioptres in limited down gaze. The distal 1cm of the muscle was visibly protruding from the conjunctival traumatic incision. The rest of the ocular examination was unremarkable, with no associated orbital fracture. Management: A primary repair of the IR was carried out the same day References: Ludwig IH, Brown MS. Strabismus due to flap tear of a rectus muscle. Trans Am Ophthalmol Soc 2001;99:53-63. 2 weeks post-op Conclusion: There is no consensus on the timing of surgery at the moment however our case supports the existing limited data that a timely repair results in an improved outcome [1,2]. Early repair in this scenario is critical and can lead to an excellent outcome, as demonstrated. Outcome: After three months of follow up, he remains asymptomatic with no deviation in primary gaze, and only a slight residual limitation of right downgaze measuring 10 dioptres right over left.