Understanding the fundamental immunological processes that play a role in tumor development will help us to better understand how to develop safe and efficient immune intervention strategies against ocular tumors and their metastases. Antitumor immune responses by T cells and antibodies may limit tumor growth, while on the other hand, the presence of tumor-infiltrating leukocytes may lead to the production of cytokines that stimulate tumor growth. In addition, environmental factors such as ocular immune privilege and aging may have an influence on intraocular tumors. Aging is associated with a phenomenon known as para-inflammation, which is a local increase in infiltrating leukocytes and cytokines. New treatments with immune checkpoint inhibitors are helping many patients, but most uveal melanoma remain resistant to the new therapies. A new treatment for HLA-A2 positive metastatic uveal melanoma with a bispecific antibody, tebentafusp, offers hope. Inducing immunogenic cell death by killing tumor cells with a photosensitizer and light may overcome local immunosuppresion and lead to effective immune responses against ocular malignancies.