Radiation retinopathy is a progressive, delayed-onset microvascular disease of the retina that occurs because of exposure to ionizing radiation. It is commonly observed in patients undergoing radiotherapy for malignancies involving structures adjacent to the eye, such as uveal melanomas, orbital tumors, or nasopharyngeal cancers. The condition typically manifests months to years after radiation exposure, with the time of onset influenced by factors such as radiation dose, fractionation schedule, and individual patient susceptibility. The pathological hallmark of radiation retinopathy is damage to the retinal vasculature, leading to endothelial cell loss, capillary nonperfusion, and breakdown of the blood-retinal barrier. Clinical features include microaneurysms, retinal hemorrhages, cotton-wool spots, and macular edema, which may progress to vision-threatening complications such as retinal ischemia, neovascularization, and tractional retinal detachment. Fluorescein angiography and optical coherence tomography are essential tools for diagnosis, providing insights into the extent of vascular damage and edema. Management of radiation retinopathy is challenging and aims to mitigate vision loss rather than provide a cure. Therapeutic approaches include antivascular endothelial growth factor (VEGF) agents, corticosteroids, laser photocoagulation, and, in some cases, vitrectomy for advanced complications. Preventive strategies, such as the use of advanced radiotherapy techniques (e.g., intensity-modulated radiation therapy), help minimize the radiation dose to the retina and reduce the risk of this debilitating condition. Ongoing research focuses on understanding the molecular mechanisms of radiation-induced retinal damage and exploring novel therapeutic options to improve outcomes. Early detection and timely intervention remain critical to preserving vision in affected individuals.