The surgical management of paediatric orbital tumours has evolved substantially over the past century, reflecting advancements in surgical technique, imaging and multimodal oncologic care. Early treatment strategies in the late nineteenth and early twentieth centuries frequently relied on radical excision, including orbital exenteration, to achieve local disease control in the absence of effective adjuvant therapies. These approaches resulted in significant functional, cosmetic and psychosocial morbidity. Starting in the mid-twentieth century, improved histopathological classification of tumours and the introduction of adjuvant therapies, including systemic chemotherapy, external beam radiotherapy and later brachytherapy in selected cases, facilitated a shift from radical resection to diagnostic biopsy and selective debulking of certain tumours. Concurrently, the development of transcranial orbitotomy and minimally invasive endoscopic endonasal approaches, supported by advances in cross-sectional imaging, allowed for improved operative planning and preservation of ocular structures. The transition towards multidisciplinary and minimally invasive approaches has been associated with high rates of tumour control and reflects a broader surgical trend towards function-preserving, organ-sparing intervention. The surgical history of paediatric orbital tumours highlights the role of technical innovation in improving long-term functional outcomes and maximising quality of life.