Primary orbital intraosseous hemangiomas are rare--only 16 cases have been reported previously. The authors describe five patients with this benign tumor. Patients ranged in age from 49 to 77 years, and each had a painless or mildly tender nodular lesion. Ophthalmic symptoms were minimal, although nasolacrimal obstruction was the original sign in one patient. Four of five patients responded well to complete tumor excision (two patients) or partial resection of the lesion (two patients). The fifth patient required a second operation for tumor progression after partial excision of the hemangioma. The 16 previously reported cases of orbital intraosseous hemangioma are reviewed, and the natural history and pathology of this rare vascular lesion are discussed.