Originally presented during Pediatric Ophthalmology Subspecialty Day 2015, Stephen Christiansen discusses this case of a young woman who presented with a horizontally incomitant left hypertropia, a severe left-eye depression deficit, incyclotorsion, and a large, left face-turn. She had a history of left-eye trauma as a child. Surgical exploration revealed irretrievable avulsion of both the inferior rectus and inferior oblique muscles. The main question asked is how should the surgeon approach the torsion and the incomitant vertical strabismus when both the primary and secondary excyclorotary muscles are lost?