Advanced treatments for retinoblastoma (RB) have saved more children’s eyes, and provided a much improved cosmetic outcome when enucleation is necessary. As recently as the 1970s, external beam radiation therapy (EBRT) was the primary treatment available, aside from enucleation. While EBRT is effective in eradicating many tumors, often there are cosmetic side effects, as the radiation may retard the growth of soft and bony tissue. As they reach maturity, children that have been treated with EBRT often exhibit narrowing of the facial structure around the eyes and sometimes, contracted eye sockets. Of course, saving the patient’s life is the physician’s primary goal and preserving vision is the next most important goal. Obtaining a positive cosmetic outcome is obviously secondary to these goals. Nevertheless, with early detection and the use of newer treatments (such as chemotherapy, radioactive plaques, laser treatment and cryotherapy), good cosmesis is expected for RB patients who require prosthetic eyes. For the ocularist, many retinoblastoma patients today present the same challenges faced with any pediatric patient, notably challenges of communication and gaining trust.