Background Endoscopic transethmoidal and prelacrimal approaches can access the medial intraconal space (MIS). Objective This study aimed to compare advantages and drawbacks of these two approaches, and to explore their appropriate indications for management of lesions at various locations within the MIS. Methods Six injected cadaveric specimens were dissected using an endonasal approach performing a transethmoidal approach on one side and a prelacrimal approach on the contralateral side. The MIS was divided into threeZones:Zone 1was defined as the area above the superior border of the medial rectus muscle (MRM),Zone 2as the area between the MRM and the optic nerve, andZone 3as the area below the inferior border of MRM. The exposure provided by these two approaches to various Zones within the MIS was assessed and compared. Results The average height ofZone 1to3was 10.35 +/- 0.45 mm, 11.07 +/- 0.59 mm, and 6.53 +/- 0.59 mm, respectively. Both approaches provided adequate exposure ofZone 2and3; however, the prelacrimal approach provided direct exposure of the posterosuperior aspect ofZone 2without retraction of MRM. Retraction of MRM was unavoidable using a transethmoidal approach to enhance further exposure. Access toZone 1was adequately achieved through the corridor between superior oblique muscle and MRM via a transethmoidal corridor. Conclusion Conceptualizing the MIS into the three aforementioned Zones seems beneficial to select the optimal approach for lesions restricted to each specific Zone. Both the transethmoidal and prelacrimal approaches provide adequate exposure for select lesions in the MIS.