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To report the surgical reconstruction of a complicated orbital depression fracture in a horse with emphasis on medial wall and globe repositioning.Clinical report.A 6 year old Irish Sport Horse gelding.The eventer presented with acute, severe orbital trauma and globe displacement. After initial elevation of the depression fractures of the facial bones and reconstruction of the orbit, the globe was recessed secondary to displacement of the medial wall and floor of the orbit within the conchofrontal sinus. A three-dimensional model of the fracture configuration was used for presurgical planning to reposition the globe. During a subsequent surgical procedure, a resorbable plate was placed in the floor of the orbit and the medial orbital wall and globe were repositioned using a sinoscopic approach and stabilized with the placement of tissue expanders within the conchofrontal sinus. The tissue expanders were subsequently removed after 3 weeks under standing sedation.The right globe was successfully repositioned in a more correct anatomical orientation and the horse resumed work 3 months postoperatively, and successfully competed at its previous level 5 months postoperatively. No visual deficits have been reported by the owners.Efforts to restore the medial wall and/or floor of the orbit with concurrent globe repositioning should be considered in horses with severe orbital depression fractures that result in abnormal globe position.