Among the ocular complications that are known to occur following the use of radiation therapy for ophthalmic cancers, radiation optic neuropathy (RON) is among the most devastating. Radiation-induced aqueous tear deficiency, dermatitis, cataract, neovascular glaucoma, and retinopathy may be treated with currently available medications and surgical therapies. Radiation optic neuropathy differs from these complications due to its complexity, location, and the biochemical events surrounding its onset. Radiation optic neuropathy develops in approximately 30% of those undergoing plaque brachytherapy for choroidal melanoma and is directly related to the radiation dose, location of the tumor, and the size of the tumor treated. There seems to be no difference in incidence with the type radionuclides used for brachytherapy. RON may be an unavoidable and untreatable complication. However, treatments have been attempted and described in small retrospective case series. Nevertheless, there is some evidence to suggest that downregulation of vaso-occlusive cytokines such as vascular endothelial growth factor (VEGF) and other inflammatory mediators with steroids and anti-VEGF agents (delivered locally) may preserve visual acuity. In addition, early hyperbaric oxygen therapy was shown to be effective in improving or stabilizing vision.