Foreign bodies in the paranasal sinuses are exceeding rare and typically result from high-velocity trauma, such as firearms or airbag deployment. The maxillary and frontal sinuses are the most commonly affected structures. Here, we describe the case of a 35-year-old man who sustained a slingshot injury while intoxicated with alcohol and methamphethamines. He initially presented to a small rural hospital with vision loss in the left eye. His transfer to a tertiary centre was delayed due to his aggression. High-resolution computer tomography revealed a 17mm round radio-opaque object that had transorbitally penetrated the eye and lodged in the sphenoid sinus. The globe was ruptured and already non-functional. Emergency endoscopic sinus surgery was performed to remove the foreign body, identified as a large ball bearing. Its size made removal through the nares or the injured eye difficult. Ultimately, the foreign body was dislodged into the pharynx and removed transorally. The patient had an uneventful postoperative recovery. Sphenoidal foreign bodies are challenging due to their rarity, limited access and proximity to vital structures. A high degree of suspicion, detailed knowledge of the anatomy and careful preoperative planning are essential. Experienced sinus surgeons may be involved as part of a muti-specialist team for their expertise in endoscopic management.