The authors evaluate the epidemiology, clinical signs, treatment and outcomes of trochleitis in a retrospective review of 59 cases. Estimated prevalence was 12 per 100,000. Eighty-six percent were female and mean age was 43±18 years. All but one case was unilateral and 56% were right-sided. Main symptom was pain. Ocular motility was present in eight patients and diplopia was reported by seven patients. Six cases were diagnosed as inflammatory Browns syndrome and 11 were diagnosed as primary trochlear headache. Medical treatment was provided for all with oral nonsteroidal anti-inflammatories (NSAIDs) as the first option in 85% and oral steroids for 3%. Topical treatment was provided for the remainder. Symptoms completely resolved for 80% with partial resolution for 14% and 7% with no improvement. Those with ocular motility limitation and diplopia responded poorest.