To comprehensively summarize the clinical and pathological characteristics of primary orbital neoplastic lesions with communication, thereby providing a solid basis for the diagnosis and treatment of such conditions.A retrospective analysis of clinical cases was conducted. The clinical and pathological data of 862 patients diagnosed with primary orbital neoplasms with communication, including orbito-cranial, orbito-nasal, and orbito-crano-nasal communicating tumors, were collected. The data covered gender distribution, age at onset, presenting symptoms and signs, imaging findings, and treatment modalities. These data were systematically summarized according to pathological diagnoses.Among all primary orbito-related communication neoplasms, meningioma was identified as the most common benign tumor (11.0%, 95/862), with a mean age of onset of 45.3 ± 12.7 years. Notably, 72.6% of meningiomas originated from the orbit, while 27.4% originated from intracranial sites. In contrast, adenoid cystic carcinoma was the most common malignant tumor (9.5%, 82/862), with a mean age of onset of 39.1 ± 12.8 years. The majority of adenoid cystic carcinomas (59.8%) originated from the orbit, whereas 29.3% originated from the sinuses. In the pediatric population under the age of 14 years, a total of 102 cases were identified. Out of these, there were 67 cases of orbito-cranial communication (65.7%), 5 cases of orbito-nasal communication (4.9%), and 30 cases of orbito-crano-nasal communication (29.4%). Optic glioma was the most common benign tumor in pediatric orbito-cranial communication (22.4%, 15/67), with an average age of onset at 5.6 ± 4.2 years. The most prevalent malignant tumor among children with orbito-cranial communication was small round cell tumor (10.4%, 7/67), with an average age of onset at 4.6 ± 3.7 years. In children with orbital-cranio-nasal communication, sarcoma was identified as the most common malignant tumor (43.3%, 13/30), with 76.9% of tumors originating from the nose. The most common benign tumor in this group was nasopharyngeal fibroangioma (16.7%, 5/30), which exclusively affected males and originated from the nasopharynx.The clinical features and pathological classification of primary orbital tumors vary significantly depending on the type of communication. Moreover, there are substantial differences in the pathological subtypes of these orbital lesions between children and adults.© 2025. The Author(s).