Penetrating orbito-cranial injuries have a potential to cause major mortality and morbidity. They can result due to a variety of numerous intentional or unintentional events. We present a case of a 35-year-old man who came to our emergency services with a penetrating orbito-cranial injury with a knife after an altercation with his friend. He underwent a right fronto temporal craniotomy and the knife was disengaged and removed under direct vision. The patient recovered without any deficits. This case highlights an unusual case, the importance of preoperative radiological imaging and meticulous surgical technique. We also review the available literature.