Orbital emphysema is an unusual complication of orbital fractures which are the common sequelae of periorbital trauma. Most cases are due to inferior orbital wall fractures. Here we report a case with an unusual clinical presentation of isolated left medial orbital wall fracture complicated with massive orbital emphysema. Without ophthalmic or neurologic defect, conservative management with cold compression and analgesics was prescribed. He was also advised not to blow his nose. On follow-up at 1 and 4 months, the orbital emphysema subsided, and the patient remained free of any optic impairment. Relevant literature is also reviewed.