The technique of endoscopic repair of orbital blowout fractures is part of a broader field of minimally invasive surgery, and has gained popularity among otolaryngologists. D. Gregory Farwell, MD, and colleagues have adopted this technique in their practice and discuss the successes and challenges of this approach. They analyzed 53 fracture repairs, 45 of which were performed endoscopically. Smaller defects confined to the medial floor were easily repaired, whereas repair of larger defects with extensive herniation was a much more difficult task. They concluded that, although endoscopic repair of orbital blowout fractures can be performed successfully, technical challenges of this operation tend to increase the difficulty of repair without improving the result. They argue that most fractures should be repaired via an open approach.