Introduction: Foreign bodies represent on average 11% of all ENT emergencies. Associated eye trauma represents 5% of all cases of blindness in developing countries. Accidental and homicidal arrow injuries presenting to an otorhinolaryngologist are still a stark reality in this modern era. Case report: A 22 year-old female presented with an accidental arrow injury in her left eye; extending into the nose. On examination, she had no light perception in left eye and a penetrating injury of the sclera. CT scan showed extensive injury to ipsilateral nasal cavity, floor of left orbit and the maxillary sinus and anterior ethmoid cells. Multidisciplinary approach ensured removal of the unusual foreign body from the orbit, nose and paranasal sinuses. Discussion: Accidental injury in ear, nose or throat with sharp projectiles presents a challenge. Arrowhead may be poisoned and thus exploration is delayed until the systemic effect of the poisoned is reduced. An injury such as this involves a multidisciplinary approach. As ENT surgeons we must be aware such challenges and equip ourselves with the knowledge to tackle them.