This case report outlines the management strategy for a 37-year-old male who suffered a penetrating left orbital injury with rupture of the inferior rectus muscle, optic nerve avulsion and vertical deviation of about 90PD. On orbit exploration, the inferior rectus muscle stump was found 25mm from the limbus and attached to sclera. Fibres were secured with 5-0 non-absorbable suture, disinserted from the globe and sutured back to sclera as anteriorly as possible – approximately 15mm from the limbus. The superior rectus was disinserted with hang back of 20mm from the original insertion. At follow-up there was mild limited left depression with full horizontal ductions. Deviation was about 20PD exotropia and 15PD hypertropia. Consultation in this case was by Orbis Cybersight telemedicine. CT imaging was helpful in locating the proximal stump of the inferior rectus. Despite no visual potential, the decision to treat was based on significant psychological and social problems due to the large hypertropia.