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Purpose: To report an unusual case of an ectopic lacrimal fistula in a setting of a naso-orbito-ethmoid fracture., Case Report: The present case demonstrates a right-sided ectopic lacrimal fistula just below the glabella on the contralateral side on the outer edge of the midline. CT-Dacryocystography demonstrated a large dilated right lacrimal sac with a partly sequestered fundus traversing through the frontal process of the maxilla and frontal bone, close to the skull base and communicating with the fistula. The connection of the fistula with the sac was severed at the superior-most point, and the long fistulous tract was removed using external and endoscopic approaches, followed by endocautery and subsequent dacryocystorhinostomy. Post-operatively, the fistulous opening healed, ostium score was FICI grade 5, and the patient was asymptomatic., Conclusion: The case demonstrates multiple surgical challenges while managing an ectopic fistula with a long fistulous tract traversing several bony structures.