Background: Paranasal sinus mucoceles are benign, mucus-filled cystic lesions that can cause significant morbidity when they extend beyond the sinuses, particularly into the orbital region. This study investigates the pathophysiology, diagnostic challenges, and management strategies of orbital complications arising from paranasal sinus mucoceles. Methods: A retrospective review was conducted on 83 patients diagnosed with paranasal sinus mucoceles presenting with orbital complications at a tertiary care center from June 2022 to June 2024. Data collected included demographic information, clinical presentation, diagnostic imaging findings, surgical interventions, pathological examination, and postoperative outcomes. Advanced imaging techniques such as CT and MRI were utilized for diagnosis, and endoscopic sinus surgery was the primary treatment modality. Results: The study comprised 83 patients, leading to a total of 94 mucoceles. The most common symptoms included bulging eyes (47.0%), double vision (15.7%), reduced vision (14.5%) and severe vision loss (10.8%). Imaging revealed that the lamina papyracea was the most frequently affected site (88.6%). Endoscopic sinus surgery was performed in 92.8% of cases, with a small subset requiring a combined surgical approach. Postoperative outcomes showed significant improvement, with a marked reduction in ocular symptoms and no recorded surgical complications. Conclusion: Early diagnosis and precise surgical intervention are crucial in managing paranasal sinus mucoceles with orbital complications. Endoscopic sinus surgery, enhanced by image-guided navigation, offers a highly effective and safe treatment option, significantly improving patient outcomes. The study emphasizes the need for a multidisciplinary approach and the importance of advanced imaging in the management of these complex cases.