Orbital blowout fracture is a common result of facial trauma and is observed more frequently now than in the past as a result of introduction of computed tomography and increased incidence of high-energy impact injuries. Because orbital fracture may be associated with prolapse of the orbital contents into the paranasal sinuses, which results in sequelae such as diplopia and enophthalmos, proper diagnosis and timing of repair are crucial. However, clinical decision-making in the management of patients with orbital blowout fractures is challenging, and various aspects of orbital fracture management are uncertain. Numerous approaches have been used for reduction of blowout fracture. Controversies exist regarding indications for surgery, timing of surgery, and optimal reconstruction material. Recently, with expanding use of and indications for endoscopy in orbital blowout fracture surgery, otolaryngologists participate more often in facial trauma surgery, including blowout fracture. In this review, several controversial issues of surgical indication, surgical timing, method of approach, and choice of reconstruction material are discussed from the perspective of otolaryngology surgeons.