Purpose To evaluate the long-term pr ognosis of visual function in patients with orbital cavernomas after conser-vative and surgical treatment.Design Interventional case series.Methods The authors describ e the outcome of 20patients with cavernous hemangioma s of the orbit treated in their departments between 1988and 2003.This prospec-tive study included five cases follo wed by clinical and ra-diologic observation and 15cases of symptomatic tumors that were completely removed by mean s of a frontotemporal or by means of a transconjunctival ap proach.The clinical characteristics of orbital cavernomas were analyzed together with their appropriate treatment.F urthermore,the authors present the unusual case of a patient suffering from pro-gressive visual deterioration from a cerebral cavernoma compressing the optic nerve.Results The follow up period was between 3and 10years.All orbita l cavernomas in the group of conservatively managed patients remained stable.The transconjunctival excision of a medially located lesion was uncomplicated.The frontotemporal approach was cho-sen for large tumors situated in the p roximity of the orbital apex and was associated with a higher number of compli-cations.A good overall outcome of visual function and patient satisfaction was achieved i n 11of 14cases operated on by craniotomy.Conclusion The com bination of clinical signs and magnetic resonance imagin g(MRI )is highly sensitive and specific for the diagn osis of orbital caver-nomas.In the presence of visual dete rioration clearly at-tributable to the tumor we recommend immediate surgery,while lesions producing solely exop hthalmos can safely be followed by observation.The transc ranial approach offers excellent exposure and a rewarding c osmetic result and may be considered for large lesions superior and medial to the optic nerve,especially if they involve the orbital apex. Purpose To evaluate the long-term pr ognosis of visual function in patients with orbital cavernomas after conser-vative and surgical treatment. Design Interventional case series. Methods The authors describ e the outcome of 20patients with cavernous hemangioma s of the orbit treated in their departments between 1988 and 2003.This prospec-tive study included five cases of follo wed by clinical and ra-diologic observation and 15cases of symptomatic tumors that were completely removed by mean s of a frontotemporal or by means of a transconjunctival ap proach.The clinical characteristics of orbital the authors present the unusual case of a patient suffering from pro-gressive visual deterioration from a cerebral cavernoma compressing the optic nerve. Results The Follow up period was between 3 and 10 years. All orbita l cavernomas in the group of conservatively managed patients remain stable. transconjunctival excisio n of a medially located lesion was uncomplicated.The frontotemporal approach was cho-sen for large tumors situated in the p roximity of the orbital apex and was associated with a higher number of compli-cations. A good overall outcome of visual function and patient satisfaction was achieved in 11 of 14 cases operated on by craniotomy. Contact The com bination of clinical signs and magnetic resonance imagin g (MRI) is highly sensitive and specific for the diagnosis of orbital caver- nomas. the presence of visual dete rioration clearly at- tributable to the tumor we recommend immediate surgery, while yield producing solely exop hthalmos can safely be followed by observation. transc ranial handle offers excellent exposure and a rewarding c osmetic result and may be considered for large lesions superior and medial to the optic nerve, especially if they involve the orbital apex