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The role of orbital exenteration in the management of malignant melanoma of the conjunctiva has been underexplored. The outcome in 95 patients with this condition, who underwent exenteration as a primary treatment (n = 36) or after failure of other treatment (n = 59) for early to advanced stages of the disease, was evaluated. The majority of treated cases had multicentric melanomas sited at prognostically unfavourable locations. In the group of tumours with a maximum thickness of 1.0 mm no melanoma related mortality was noted. Melanomas thicker than 1.0 mm were associated with a mortality varying between 33% and 50%, independent of whether exenteration was performed as primary or secondary treatment. An especially poor outcome was noted for the group of caruncular melanomas despite exenteration. These findings indicate that total eradication of tumour should be performed at an early stage. For this purpose, a combination of debulking surgery and adjunctive cryotherapy or beta radiotherapy is more appropriate than orbital exenteration which causes disfigurement and blindness. Exenteration of the orbit should be reserved as a palliative procedure for advanced stages of neoplastic disease.