Retinoblastoma is the most common eye cancer in childhood, with enucleation rarely being the only lifesaving surgical option, especially where evidence of extraocular spread is apparent. This study sought to survey a global pool of eye care professionals with regards to reasons for refusal of enucleation. One hundred and thirty-four ophthalmologists and oncologists were identified in 53 separate countries. The primary aim was to elucidate rate of enucleation refusal, and then subsequently factors contributing to refusal. Out of the 134 physicians identified, 34% completed the online survey. Fifty-three percent of respondents were from high income countries. Rate of initial refusal of enucleation was 62%, and was similar between both high and low income countries. Proportionally, doctors in low income countries were more likely to try and change a parent’s mind about enucleation. Main contributing factors to refusal for enucleation included lack of support, social stigma and prevailing societal belief in alternative treatments. This study serves to recognise some of the significant barriers to treatment that exist in this challenging condition. It is lacking, however, in that there is no data as to the stage of disease at which this was offered, and what support teams were around individual physicians at the time of survey.