Vascular lesions are classified into tumours and malformations, and malformations are further classified into high-flow and low-flow lesions depending on the haemodynamic characteristics, and there can be combinations of various lesions. The classification of vascular lesions are detailed in the ISSVA (International Society for the Study of Vascular Anomalies). Distensible venous malformation (Common venous malformation [Common VM]), previously known as varices, is the most common type of vascular malformation in the orbit and periorbital region. It is mostly sporadic, but in about 1–2% of cases, it can be familial. It occurs at the venous end of the vascular system and communicates with the venous circulation, thereby causing an increase in size with Valsalva manoeuvre. Common VM is usually present at birth and enlarges with hormonal changes during adolescence and adulthood. Occasionally, there is sudden expansion due to bleeding.