Background <p>Painful blind eye (PBE) is a debilitating condition with limited and often unsatisfactory treatment options. This study describes our clinical experience with ultrasound-guided pulsed radiofrequency (PRF) of the stellate ganglion for pain management in PBE patients.</p> Methods <p>This prospective case series included 20 consecutive PBE patients with chronic pain unresponsive to initial medical management. All underwent ultrasound-guided PRF of the stellate ganglion after a positive diagnostic block. Pain severity was assessed using the Numerical Rating Scale (NRS) at baseline and at multiple follow-up points for up to one year. The primary outcome was the change in NRS score. Secondary outcomes included analgesic use and the need for further interventions.</p> Results <p>The median NRS score significantly decreased from a baseline of 8.66 (IQR: 8.32–9.11) to 2.07 (IQR: 1.46–2.70) at one year (<i>P</i> &lt; 0.0001). The need for analgesic medications was significantly reduced (<i>P</i> &lt; 0.0001), and no patient required subsequent retrobulbar injections or surgical enucleation/evisceration. No major adverse events were reported.</p> Conclusions <p>In our experience, ultrasound-guided PRF of the stellate ganglion was a promising and well-tolerated, globe-sparing treatment for refractory pain in PBE. While these preliminary findings are encouraging, this was a small, uncontrolled case series. Therefore, the effectiveness of this technique requires confirmation in larger, controlled trials before it can be widely recommended.</p>