Purpose <p>To evaluate the efficacy of trans-scleral retinal cryotherapy in the management of retinal hemangioblastoma (RH) including in von Hippel Lindau disease (VHL).</p> Methods <p>Retrospective cohort study of 24 patients (21 with VHL) receiving trans-scleral cryotherapy performed to RH lesions, with lesion characteristics and visual acuity (VA) assessed pre and post treatment using color photographs, optical coherence tomography and recorded clinical notes.</p> Results <p>Thirty-six lesions in 26 eyes received cryotherapy, with a mean follow up of 6.7 ± 3.5 years. Mean pretreatment VA was 69.7 ± 20.4 letters (Snellen equivalent of 20/40); 8 (22%) lesions were classified as clusters containing multiple RHs. Twenty-one (64%) lesions underwent retreatment using any modality and 15 (57.7%) eyes had treatment success (14 total success and 1 partial success). The average VA change at 1 year for patients with ≥ 1 year of follow-up was − 4.6 letters (<i>p</i> = 0.36 for VA change from baseline). In a logistic regression model, lower patient age at the time of cryotherapy trended towards increased odds of success (Odds ratio 1.085, 95% CI 1.00–1.180), but no other analyzed factor was statistically significantly associated with treatment success.</p> Conclusions <p>Trans-scleral retinal cryotherapy can be effective in treating RHs. A significant proportion of these eyes progress despite cryoablative treatment.</p>