Objectives: Orbital lymphatic-venous malformations (LVMs) are rare congenital anomalies that can cause significant functional and aesthetic impairments. Case presentation: This case report details the comprehensive treatment of a 47-year-old male with a longstanding orbital combined slow-flow vascular malformation. Diagnostic evaluation included magnetic resonance imaging and a sonographically guided core needle biopsy, which confirmed a benign lymphatic-venous malformation. The treatment started with minimally invasive sclerotherapy to reduce lesion size, followed by surgical debulking to alleviate proptosis and mechanical restrictions. Finally, reconstructive surgery addressed residual eyelid deformities, including ectropion and ptosis. Post-treatment outcomes demonstrated stable visual function, improved eyelid position, and a significant enhancement in the patient's aesthetic appearance and quality of life. Conclusions: The staged, multimodal approach underscores the importance of individualized treatment planning and interdisciplinary collaboration. This case highlights the potential for excellent functional and aesthetic outcomes in the management of complex orbital LVMs when nonsurgical and surgical techniques are strategically combined.