Cadaver studies and clinical evidence are presented to suggest that medial wall fractures are often concomitant with orbital floor fractures. The medial wall fractures are located in the ethmoid bone midway between the medial canthus and the lesser wing of the sphenoid. These fractures may be the etiology of late enophthalmus. The discrepancy between the high frequency of occurrence of medial wall fractures in this study and the rarity of clinical diagnosis derives from the limitations of standard radiography. Computed tomography (CT scan) is useful in delineating these fractures. The operative approach is through an incision above the medial canthus. Surgical treatment includes reduction of the herniated periorbital fat and coverage of the defect with autogenous, homologous, or alloplastic materials.