Currently, endoscopic endonasal reduction and transcaruncular reduction are frequently used as surgical treatments for medial orbital wall fractures. However, these 2 surgical techniques have not been comprehensively compared using objective criteria. Therefore, the results of these 2 techniques were compared retrospectively using 8 objective criteria in patients with medial orbital wall fracture. This study included 48 medial orbital wall fracture patients treated from June 1993 to July 2006: 29 had endoscopic endonasal reduction and 19 had transcaruncular reduction. Computed tomographic scans, double vision field testing for diplopia using Goldmann perimetry, and Hertel exophthalmometer (Richmond Products, Albuquerque, NM) were done pre- and postsurgery. The average follow-up period was 70.8 months. Among patients with pure medial orbital wall fractures, the average reduction rate was 89.2% for the endoscopic endonasal reduction group and 90.7% for the transcaruncular reduction group. One case in the endoscopic endonasal reduction group had a more than 2-mm enophthalmos after surgery. The diplopia correction rate was 1.8% in the endoscopic endonasal reduction group and 2.7% in the transcaruncular reduction group. None of the above differences was statistically significant. However, among patients with pure medial orbital wall fractures compared with the transcaruncular reduction group, the average operation time, the average hospital stay, and the average cost were significantly greater in the endoscopic endonasal reduction group. The 2 surgical methods had a similar effectiveness; however, transcaruncular reduction seemed to be more advantageous with respect to the operation time, the length of hospital stay, and cost.