With the advent of noninvasive neuroimaging of the orbits and brain, many asymptomatic patients with intraorbital optic gliomas have been identified. These children, predominantly with neurofibromatosis, present a therapeutic quandary to the treating physician. There is no consensus regarding either the natural history of intraorbital optic gliomas or the approach treatment. This paper reviews the literature on the treatment of 227 children with intraorbital optic gliomas with surgery, radiation or 'watchful waiting'. Based on this review, an approach to the management of children with intraorbital optic gliomas with and without neurofibromatosis is suggested.