We present our ocular clinicopathologic findings of a child who suffered bilateral perforation of the globe during medial rectus recession bilaterally for congenital esotropia. The right eye progressed to a painful phthisis bulbi and subsequently required enucleation. Penetration or perforation of the sclera during extraocular muscle surgery is not rare; however, serious sequelae such as visual loss or loss of the eye are unusual. Such complications can be avoided if the surgeon is aware of the causes, as well as the dangers, of such perforation, and, in particular, if modern spatula-type needles are used.