Globe-sparing transorbital penetrating injury with sinonasal extension caused by a nail gun

We report the case of a woman in her 40s who sustained a left transorbital penetrating injury caused by an accidentally discharged nail from a nail gun. On presentation, visual function was preserved despite visible medial canthal penetration. CT demonstrated a medial extraconal trajectory, adjacent to the medial rectus muscle, traversing the ethmoidal air cells and approaching the sphenoid sinus without intracranial involvement or optic nerve damage. Multidisciplinary management involving ophthalmology and otorhinolaryngology enabled controlled external extraction of the foreign body. A hook-like metallic protrusion along the shaft of the nail caused resistance during removal, increasing the risk of secondary tissue injury. The patient achieved complete recovery, with preserved visual acuity and no neurological or functional sequelae. This case highlights the importance of prompt imaging, coordinated surgical planning and structured follow-up in orbital penetrating trauma.