OBJECTIVE To describe the technique and indications for an endoscopic-assisted approach to orbital roof lesions. METHODS The technique was used for six cases of orbital roof lesions. An anterior orbitotomy was performed via an upper eyelid skin crease incision. Areas of the lesion behind the superior orbital rim or abutting the dura were removed with the aid of a rigid Storz 3-chip video-endoscope with 30-, 45-, or 70-degree tip. RESULTS Six patients with lesions involving the orbital roof were treated using endoscopic-assisted curettage. There were five males and one female with a mean age of 39.6 years (range, 5 months to 67 years). There were two cases each of cholesterol granuloma, Langerhans' cell histiocytosis, and orbital dermoid. The lesions were successfully removed in all cases with a good outcome. Average follow-up was 2.6 years; range, 6 months to 5 years. CONCLUSIONS This technique may be suitable for selected erosive lesions of the superior orbit involving the orbital roof.