The superior orbital fissure syndrome is an uncommon complication of craniofacial fractures: middle-third facial fractures and lesions of the retrobulbar space. This article reviews the anatomy and etiology of the superior orbital fissure as it relates to pathophysiology and physical findings. Cases reported in the literature are reviewed, emphasizing diagnosis and established treatment options. Two cases are presented and their management discussed, including the use of pre- and postoperative steroids as an adjunct to standard fracture reduction and stabilization therapy.