Radiation therapy can be used to maintain useful vision by avoiding enucleation to obtain local control in ocular malignancies. This can be accomplished by a variety of radiation techniques, which are prescribed according to the extent of tumor involvement. The eye can also be secondarily involved by tumors arising from adjacent structures, such as tumors of the nasopharynx, nasal cavity, and paranasal sinuses. Sophisticated radiation treatment planning must be used in either case to maximize control of disease while reducing risk for radiation sequelae. Uninvolved structures should be excluded from treatment using available treatment options that precisely localize the distribution of radiation dose. Prevention of sequelae remains the primary goal of any radiotherapy plan. Treatment of symptomatic ocular effects of radiation can range from conservative therapy with ophthalmic medications to enucleation.