BACKGROUND: Long-term follow-up is essential for retinoblastoma survivors, as treatment-related sequelae can emerge years after therapy. METHODS: This case series reviews 67 eyes treated with periocular and/or intravitreal chemotherapy from 2005 through 2020. RESULTS: Periocular chemotherapy was associated with orbital fibrosis in 79.1% of cases, with risk increasing concomitantly with the number of injections. Cataracts developed in 19.4% of eyes, with 10 out of 13 requiring cataract extraction. Other complications included chronic conjunctivitis and limbal stem cell deficiency (3% each), while strabismus was observed in 29.9% of which 7.5% underwent strabismus surgery. Comparative analyses of periocular and anterior segment complications from other retrospective studies are included to contextualize our findings. CONCLUSIONS: Understanding these long-term sequelae is crucial for appropriately following and managing retinoblastoma survivors who were treated during this era. We highlight the importance of vigilant surveillance as treatment protocols continue to evolve.