Introduction The strongest predictor of treatment outcome in patients with retinoblastoma is the national income of their country. Here, we report on ten years of retinoblastoma treatment in a Kenyan tertiary referral and teaching hospital. Methods Children newly diagnosed with retinoblastoma who were treated at the pediatric oncology ward between January 2012 and December 2021 were included in this retrospective record review study. The probability of event-free survival (pEFS) was estimated with the Kaplan-Meier method. Hazard ratios (HR) were calculated to assess the effect of covariates. A competing risk analysis was performed to estimate the probability of progressive disease, relapse, death and abandonment. Results Of the 106 patients whose records were reviewed, 75% presented with stage 4 disease or higher (Reese-Ellsworth classification) and 25% had central nervous system (CNS) metastases. Two-year pEFS was 25.2% (95% CI 0.17–0.38). The reasons for treatment failure were abandonment (n=39), progressive or relapsed disease (n=17) and death (n=9). No health insurance or CNS metastases negatively affected pEFS (HR 3.87, 95% CI 2.29–6.53, p<0.001 and HR 4.76, 95% CI 2.66–8.51, p<0.001 respectively). Patients who received radiotherapy had a borderline significantly higher pEFS than those who were eligible but did not (HR 0.39, 95% CI 0.14-1.08, p=0.06). Conclusion The survival rate of patients diagnosed with retinoblastoma was low. The main challenges were advanced disease at presentation and abandonment. Raising awareness and early referral is key to improve survival. However, as long as patients present with advanced disease, efforts should focus at ensuring that patients complete treatment, including radiotherapy.