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The management of orbital floor fractures involves several issues. Different surgeons have diverse opinions about who needs surgery and how best to do it. This is especially so with regard to use of transantral diagnostic and therapeutic endoscopic surgery over traditional lower eyelid approaches. Transantral endoscopy provides precise and complete information about the orbital floor fracture and makes possible the repair of these fractures under unobstructed vision at all times, minimizing the risk of implant misplacement and, hence, enophthalmos. Contrary to popular belief, this technique is versatile and is applicable for most cases of primary repair of orbital floor fractures of variable sizes of defect, regardless of whether they are blowout or trap-door fractures or whether they are associated with other fractures. The great strength of this procedure is that improved visualization is accomplished while obviating the need for lower eyelid incisions and their associated risk of complications. This technique is safe in trained hands, giving predictably good results in suitable patients.