Isolated orbital roof fractures are rare. In the pediatric population, however, the lack of pneumatized frontal sinuses makes them more susceptible to such injuries. In evaluating these injuries, maxillofacial computed tomography is a necessary adjunct to a complete history and physical evaluation. Based on the relative position of bone fragments, orbital roof fractures can be classified as non-displaced, blowout, or blow-in. While many patients can be safely managed with careful observation. Symptoms such as extraocular entrapment, vertical dystopia, diplopia, or cerebrospinal fluid leak may require surgery. Many different approaches to the orbital roof are available; selection needs to be made based on surgeon experience and location of injury. Cooperation between neurosurgery, ophthalmology and head and neck surgery are essential to optimize the care for these patients.