The Tolosa-Hunt syndrome, or painful ophthalmoplegia, is a rare condition caused by a granulomatous nonspecific process at the level of anterior cavernous sinus, superior orbital fissure and orbital apex. The syndrome is characterized by pain behind, above or around the eye, involvement of the cranial nerves which pass through the cavernous sinus, spontaneous remissions and exacerbations, and a favourable response to steroid therapy. Recognition of this condition is important because administration of steroids may prevent residual damage.