Background: Aspiration cytology is a critical diagnostic tool in evaluating intraocular and periorbital adnexal lesions, providing rapid, minimally invasive diagnostic information. These lesions encompass a broad spectrum of benign and malignant conditions, necessitating accurate diagnosis for appropriate management. Objective: This study aimed to assess the diagnostic accuracy, clinical utility, and limitations of aspiration cytology in intraocular and periorbital adnexal lesions, identifying the spectrum of cytological findings and correlating them with histopathological diagnoses. Methods: A retrospective analysis was conducted on 150 cases of intraocular and periorbital adnexal lesions evaluated by aspiration cytology over five years. Data on patient demographics, lesion characteristics, cytological diagnoses, and subsequent histopathological findings were collected and analysed. Diagnostic accuracy was calculated based on histopathological correlation. Results: Inflammatory lesions (40%) and benign neoplasms (35%) were the most commonly diagnosed. Malignant lesions accounted for 20% of the cases, with a sensitivity of 90% and specificity of 95% in distinguishing benign from malignant lesions. Aspiration cytology showed high concordance with histopathological findings in most cases. Conclusion: Aspiration cytology is a valuable diagnostic tool for intraocular and periorbital adnexal lesions, offering high diagnostic accuracy. Its role is particularly significant in differentiating between benign and malignant lesions, aiding in timely and appropriate clinical management.