Introduction: Foreign body piercing orbital floor and entering maxillary antrum is a rare scenario, and has to be managed in a meticulous fashion to avoid further complications. Transnasal endoscopic surgery is one of the methods for gaining access to both orbit as well as the maxillary antrum through a single approach. Case description: We report a case of a 40-year-old female with history of assault to the right eye using a pen. There was a J-shaped sutured wound present over medial aspect of the right eye with upper eyelid edema and a swelling medial to the right medial canthus. Computed tomography scan showed the presence of well-defined cylindrical structure measuring 46 × 9 mm noted in extraconal compartment inferomedial to right eyeball penetrating to floor of the orbit and reaching till posterior wall of right maxillary sinus. Patient was managed using transnasal endoscopic approach under general anesthesia. The postoperative period was uneventful, with complete resolution of complaints. Conclusion: A detailed history with relevant radiological imaging plays an important role in diagnosis of orbito-maxillary foreign bodies (FB) and also for planning the management. Approach to these FB varies based on their composition, size, and location. Therefore, proper surgical planning is important and will result in a good outcome with minimal complications.