Orbital hypertelorism may be seen in isolation or more commonly within the context of other congenital craniofacial dyscrasias such as craniosynostosis, midface hypoplasia, exorbitism, atypical orofacial clefting, and malocclusion. Careful consideration of the preoperative cranial, orbital, and midface phenotypes, as well as the time of intervention, is imperative to choosing the optimal surgical approach to orbital repositioning. Virtual surgical planning serves as a powerful tool to increase surgical accuracy, decrease skeletal relapse, and mitigate historical complication profiles.