This prospective study evaluated the impact of simultaneous ipsilateral superior rectus (SR) recession and superior rectus (IO) anterior transposition on the primary position alignment in six patients with traumatic loss of the inferior rectus (IR) muscle. Five males and one female were aged 30-45 years. Preoperative primary hypertropia of 44.16 ±4.91PD increased to 65.83±5.84PD in downward ipsilateral gaze with marked limitation of depression in abduction and A pattern. IR limitation was -3 to -4. At 12 weeks postoperatively three patients were orthophoria in primary position. The remainder had 4-7PD of vertical deviation. Depression in abduction improved in all. The authors propose early intervention to prevent SR contracture, scarring and fibrosis at the site of injury.