This is a review of orbital cavernous haemangiomas (orbital cavernous venous malformations) managed over a 12-year period at a tertiary referral centre. Painless proptosis was the commonest presentation. One hundred and sixty-four patients (96 female and 68 male) underwent surgery via a lateral orbitotomy in 87 and an anterior orbitotomy in 77. Complete removal was achieved in all cases, but some required volume reduction by partial exsanguination. Exophthalmometry, visual acuity, ocular motility and diplopia, visual fields, ptosis, choroidal folds and disc oedema all improved significantly compared to preoperative values. Complete loss of vision occurred in two patients and was associated with apical extension. Five patients developed a tonic pupil from surgery, and this was associated with a postero-lateral location of the haemangioma. Five patients developed de novo diplopia postoperatively. This is a large series with useful data on the complication rates from surgery. As expected posteriorly located tumours were associated with higher risks of postoperative visual loss and pupil abnormalities.