The fossorial amphisbaenians, or worm lizards, are characterized by a suite of specialized characters in the skull and postcranium, however fossil evidence suggests that at least some of these shared derived traits evolved convergently. Unfortunately the lack of detailed knowledge of many fossil taxa has rendered a more precise interpretation difficult. Here we describe the cranial anatomy of the oldest-known well-preserved amphisbaenian, Spathorhynchus fossorium, from the Eocene Green River Formation, Wyoming, USA, using high-resolution X-ray computed tomography (HRXCT). This taxon possesses one of the most strongly reinforced crania known among amphisbaenians, with many dermal bones overlapping each other internally. In contrast to modern taxa, S. fossorium has a paired orbitosphenoid, lacks a true compound bone in the mandible, and possesses a fully enclosed orbital rim. The last feature represents a highly derived structure in that the jugal establishes contact with the frontal internally, reinforcing the posterior orbital margin. S. fossorium also possesses a strongly modified Vidian canal with a previously unknown connection to the ventral surface of the parabasisphenoid. Comparison with the closely related fossil taxon Dyticonastis rensbergeri reveals that these derived traits are also shared by the latter species and potentially represent synapopmorphies of an extinct Paleogene clade of amphisbaenians. The presence of a reinforced orbital rim suggests selection against the loss of a functional eye and indicates an ecology potentially different from modern taxa. Given the currently accepted phylogenetic position of Spathorhynchus and Dyticonastis, we predict that supposedly ‘unique’ cranial traits traditionally linked to fossoriality such as a fused orbitosphenoid and the reduction of the eye show a more complex character history than previously assumed, including both parallel evolution and reversals to superficially primitive conditions.