Proper treatment of posttraumatic enophthalmos is based on an understanding of the anatomy of the orbit and the pathophysiology of orbital injury. Fractures of the zygoma produce enophthalmos from displacement of the lateral wall of the orbit and enlargement of the volume behind the axis of the globe. Treatment is dependent on complete reduction of the displaced bone, which repositions both the bony orbit and the associated soft tissues. Blowout fractures of the orbit occur from internal fractures along the floor and medial walls in areas of minimal bone fitness. Diagnosis requires a computed tomography examination, and treatment is dependent on repositioning of the soft tissues into the orbit with closure of the defect. The most common causes of posttraumatic enophthalmos, as well as incomplete correction following secondary procedures, are failure to adequately identify the medial wall fracture in blow-out injuries and failure to adequately reduce the zygoma at all three buttresses. Adherence to proper diagnosis and treatment can minimize the incidence of this complication and allow secondary reconstruction to be successful, even in long-standing cases.