OBJECTIVE The management of cancer metastatic to the orbit and ocular adnexa (eyelid and periocular structures) has changed in recent decades. The purpose of this article is to review the incidence, presentation, and clinical features of metastatic tumors of the orbit and ocular adnexa and discuss their multidisciplinary care. RESULTS The improved survival of patients with common cancers such as breast cancer and prostate cancer, together with aging of the population has led to a higher incidence of patients living with metastatic disease in unusual sites such as the orbit and ocular adnexa. Furthermore, vigilant surveillance and advances in diagnostics have led to increased detection of orbital metastases. Treatment of metastatic lesions in the orbit and ocular adnexa is usually palliative and may include radiotherapy, chemotherapy, hormonal therapy, surgery, or a combination of these modalities. CONCLUSIONS Breast carcinoma continues to account for the majority of metastatic lesions of the orbit and ocular adnexa. Although the overall prognosis for patients with such lesions remains poor, the longer survival time for patients with breast carcinoma, the availability of novel targeted treatment options and new investigational agents, and advances in radiotherapy techniques may lead to better quality of life and preservation of ocular function for patients with metastatic orbital tumors.