Vascular malformations of the orbit present special diagnostic and therapeutic challenges for the ophthalmologist. The haemodynamic characteristics and localisation of these lesions play a key role for therapy planning. Thorough clinical and radiological examinations are indispensable for patient counselling. Any decision for surgical intervention should be made on an individual basis after careful consideration of the intra- and postoperative risks. An interdisciplinary approach by an experienced team of radiologists, interventional radiologists, maxillofacial surgeons and ophthalmologists is in many cases necessary in order to achieve an optimal therapeutic result.