Twenty-nine patients with orbital blow-out fractures are reviewed. The approach to management and the criteria for surgery are discussed and the results of surgical and non-surgical treatments reported. Of the 16 patients treated surgically, 3 (18.75%) required a second operation, indicating failure of primary management. All 13 patients for whom surgery was thought not to be indicated, recovered without complications. The incidence of associated severe ocular injuries (31%) is high and indicates the need for a full ophthalmological assessment. The potential role of computed tomography in the management of blow-out fractures is discussed.