Objective To analyze the clinical, ultrasound Sonogram features of orbital and adnexal lymphomas. Methods The clinical, ultrasound data of patients with orbital and adnexal lymphoma (79 cases) and orbital inflammatory pseudotumor (68 cases) from January, 2017 to September, 2021 were retrospectively analyzed. And statistically significant features were subjected to binary logistic regression analysis to establish a prediction model for distinguishing lymphoma from orbital inflammatory pseudotumor. The diagnostic accordance rate of ultrasound and MRI was also compared and analyzed. Results When comparing lymphoma with orbital inflammatory pseudotumor, there were significant differences in age, gender, lesion involves the number of quadrants, maximum tumor diameter, internal echogenicity, morphology, border, aspect ratio, internal strong echogenicity, "cast" tumor and "inverted triangle" tumor (P<0.05); as suggested by multivariate logistic regression, Logit (P) = -4.426 + 1.506 age ≥ 57.5 years + 1.473 male + 1.732 internal echogenicity (low/very low/nearly absent) + 1.888 casts + 1.356 strong internal dotted-line reticular echogenicity + 1.111 internal inhomogeneity. The area under the model curve was 0.913, and when judged as lymphoma by Logit (P) ≥ 0.556 and orbital inflammatory pseudotumor by Logit (P) < 0.556, the sensitivity was 82.9%, specificity 89.7%, and Youden index 0.720. The diagnostic accordance rate between ultrasound and MRI was 84.9% . Conclusion Orbital and adnexal lymphoma has characteristic ultrasound manifestations. The diagnostic model established by combining clinical and ultrasound features has clinical significance for the diagnosis and identifying of orbital lymphoma, and there is some agreement between ultrasound and MRI diagnosis.