When properly used in well-indicated patients, fine needle aspiration biopsy of orbital lesions is an invaluable adjunct diagnostic technique. In experienced hands, the success rates have been high and the complications rare and minor. If the protocols are not followed or the surgeon is inexperienced, serious complications may result. A recent survey among 202 oculoplastic and orbital surgeons, with a total of 152 patients, confirmed this. In 138 patients, the biopsy was performed by an oculoplastic or orbital surgeon, and 10 minor complications were reported. Eleven out of the 14 remaining patients were seen by an oculoplastic or orbital surgeon in consultation for complications arising from a fine needle aspiration biopsy of the orbit performed by someone else. Complications in this group of patients included orbital hemorrhage requiring orbital decompression, motility disturbance, ptosis, and blindness. There were three deaths.