<p>To investigate the clinical and radiologic characteristics, treatment outcomes, and management strategies for orbital incidentalomas. We retrospectively reviewed 43 patients with orbital tumors incidentally identified through imaging conducted for unrelated reasons between March 2015 and July 2023. Data on imaging indications, clinicoradiologic features, diagnoses, treatments, and outcomes were analyzed. Patients were divided into surgery (<i>n</i> = 14, 32.6%) and observation (<i>n</i> = 29, 67.4%) groups for comparison. Among the 43 cases, 20 patients (46.5%) were male, with a mean age of 57.1 years and a mean follow-up of 2.77 years. Initial imaging was most commonly conducted for health check-ups (48.8%), headaches (27.9%), or dizziness (14.0%). Common clinical signs included proptosis (41.9%), peripheral diplopia (21.4%), and hypoglobus (9.3%). Benign lesions, such as cavernous venous malformations (55.8%) and schwannomas (27.9%), predominated, with one case of lymphoma. The surgery group more frequently exhibited clinical signs and anterior tumor locations (71.4% vs. 13.8%, <i>p</i> = 0.001). Surgical excision was successful without complications. In the observation group, tumor stability was noted in 96.6% without functional deficits. Orbital incidentalomas are often benign and asymptomatic. Observation is recommended for asymptomatic posterior orbital lesions, while surgical removal is indicated for anterior lesions with significant clinical signs.</p>