We report a 5-year follow-up of 22 consecutive patients, who underwent transconjunctival management of their orbital lesions without muscle dissection. The presentation, natural history, management, surgical appraisal of the transconjunctival approach and its indications are discussed. At follow-up, 21 of the patients showed excellent cosmetic and functional results. Our experience suggests that this approach remains a useful modality, with good intraoperative visibility and minimal postoperative scar formation, for managing selected patients with space-occupying lesions located in the inferior medial and basal compartment of the orbit. Not suitable for the transconjunctival approach are deep intraconal lesions (in the orbital apex) and extraconal superior lesions. Rare complications of transconjunctival approach have included temporary eye muscle injury with ophthalmoplegia postoperatively. More recently, the use of the transconjunctival approach has allowed surgeons to reduce cosmetic failures, functional deficits and deformities of the orbit. Because of its low risks, the absence of postoperative bleeding, and the limited hospitalization and immobilization of the patients, the transconjunctival approach is a successful procedure especially in elderly patients with intercurrent disease.