Common etiologies of orbital tumors differ significantly between children and adults. For example, rhabdomyosarcoma, one of the most common primary pediatric orbital malignancies, rarely occurs in adults. A detailed knowledge of specific pediatric orbital diseases and their common presentations helps develop a differential diagnosis and guide management. There are many aspects of history, examination, and imaging that aid in the differential diagnosis of orbital lesions in children. However, signs and symptoms of each tumor are not entirely specific, and the surgeon must be prepared to consider atypical presentations.