In a survey the diagnostic usefulness of standardized echography in orbital disease is demonstrated. Considering differential diagnoses it is stressed that ultrasonically determined location and size of the orbital lesion will not do alone. The main object is to achieve a specific diagnosis by way of tissue differentiation. The method is based on standardized A-scan supplemented by contact B-scan and Doppler sonography. Middle and posterior orbit is examined by transocular techniques. A paraocular approach is used for more anterior lesions. From personal experience from more than 300 orbital tumours examples are forwarded illustrating quantitative echography (internal structure, reflectivity, sound attenuation), topographic echography (borders, shape, location), and kinetic echography (consistency, mobility, vascularity). The combination of all nine criteria gives important guidelines concerning the specific lesions met in the orbit and paraorbital regions. The correlation between acoustic and histopathological features is stressed.