Objective To investigate the effect of targeted surgical approaches on the short- and medium-term prognosis of deep orbital cavernous hemangioma.Methods The data of 120 patients with deep orbital cavernous hemangioma who underwent surgery in our hospital from May 2013 to September 2018 were retrospectively analyzed. According to the surgical approaches, they were divided into transconjunctival approach group (33 cases, anterior orbitotomy), transcutaneous approach group (30 cases, anterior orbitotomy), lateral approach group (31 cases, lateral orbitotomy), and combined medial and lateral approach group (26 cases, medial transconjunctival approach combined with lateral orbitotomy). Visual acuity, exophthalmos, serum inflammatory factors, complications and short- and medium-term prognosis were compared among the four groups.Results There was no significant difference in visual acuity, exophthalmos, the overall incidence of postoperative complications, and the residual rate and recurrence rate at 1 year and 3 years after operation among the four groups (P > 0.05). The serum levels of IL-6, IL-8, TNF-α, and CRP were not different among the four groups before the treatment (P > 0.05), but were different among the groups after the treatment (P < 0.05).Conclusions The four surgical approaches for the treatment of deep orbital cavernous hemangioma exhibit similar efficacy and short- and medium-term prognosis. The optimal approach should be selected according to the specific location and the progression of the tumor, as well as the adjacent anatomical structures.