The use of a transcaruncular approach to the medial orbit provides excellent exposure of the medial wall and avoids a cutaneous scar. This article presents the clinical procedure in a retrospective study of 8 patients. An incision through the caruncle, combined with an incision along the inferior conjunctival fornix, provides wide exposure of the medial and inferior orbit. Traumatic fractures of the orbit typically involve the thin bone of the medial and inferior walls. The clinical history and findings in 8 patients with bony orbital fractures are presented. In each case, surgical repair was based on the transcaruncular approach. Results of postoperative evaluation (range of 24 days to 32.5 months) are described, with a mean follow-up period of 8.5 months. The authors conclude that the transcaruncular approach is well suited to surgical repair of blow-out fractures to the medial orbit, in combination with an inferior transconjunctival incision.