Orbital exenteration is the removal of all the orbital contents including the periorbita and eyelids. The aim of exenteration is to achieve local control of disease extending to the orbit while preserving normal tissues whenever possible to optimize surgical rehabilitation. Subtotal exenteration (eyelid sparing, conjunctiva sparing) is a modification of exenteration to aid healing and cosmetic rehabilitation. If the bone of the orbit is invaded, an “extended” exenteration is required that includes resection of the diseased bone. The ethmoids, maxillary wall, and zygomatic bone are commonly resected in extended orbital exenteration. Orbital invasion by periocular cutaneous malignant tumors (basal cell carcinoma, sebaceous gland carcinoma, squamous cell carcinoma, and melanoma) remains the most common indication for orbital exenteration. Other indications include tumors arising in the conjunctiva, orbit, globe, or paranasal sinuses. Orbital reconstruction, an integral component of the procedure, can be achieved by local methods (healing by secondary intention [laissez-faire], split-thickness skin graft, or dermis fat graft), locoregional advancement flaps (pedicle flaps, temporalis muscle transfer, frontalis rotational flap, or temporoparietal fascial flap), or microvascular free flaps.