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Minor and major complications can occur during endoscopic sinus surgery. Damage to an anatomic structure ad-jacent to a sinus is always a possibility during ESS. The lamina papyracea is very thin and may be fractured withrelatively minor truma. The presence of orbital fat, as well as the distorted anatomy at the fracture site, may makeendoscopy sinus surgey difficult or impossible because orbital fat is a landmark that surgeons should not crossfor fear of injury to orbital content, such as extraocular muscles, vasculature, and neural structures. If there maybe combined disruption of the medial orbital wall with orbital blowout fracture, orbital complication after ESSmay be very high. We report a case of endoscopic sinus surgery of chronic sinusitis and nasal polyps associatedold medial blowout fracture with a review of literature.