Purpose Orbital floor fractures are common fractures of the facial skeleton, with isolated injuries comprising ~10% of facial trauma and being involved in ~35% of all facial fractures, and are often the result of motor vehicle trauma, assault or contact sports injuries. Established absolute indications for surgical management include muscle entrapment, severe globe displacement, or acute significant enophthalmos with aesthetic or functional significance. However, there are a number of relative indications, including diplopia on primary gaze, restricted globe motility, significant orbital floor defect and inferior rectus rounding, that remain equivocal. Furthermore, there are no clear guidelines as to the optimal timing or implant choice in these cases. Methodology: We present a review of the literature summarising the indications, preferred timing and preferred implant choice in the management of orbital floor fractures. Results: For relative indications, defect size 1.5cm or larger was weakly predictive and IR index >1 was not predictive for development of late enophthalmos. Earlier operating (within 14 days) was found to be significantly superior in reducing rates of diplopia and enophthalmos. There was no significant difference in complication or reoperation rate between resorbable and non resorbable implants, nor between different resorbable implants except for poly-L-lactic acid (PLLA) and polydioxanone, which had increased risk of delayed inflammation requiring explant, and enophthalmos, respectively. Conclusion: Whilst earlier surgical intervention confers significant benefit, choice of implant remains largely equivocal. The outcomes of surgical vs conservative management would provide further valuable insight.