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Purpose: To evaluate the long-term efficacy and outcome of low-dose proton beam irradiation in the treatment of symptomatic circumscribed choroidal hemangioma., Patients and Methods: Retrospective review of 71 patients with symptomatic circumscribed choroidal hemangiomas treated by proton beam irradiation between September 1994 and October 2002 using a total dose of 20 Cobalt Gray Equivalent., Results: The median follow-up was 52 months (8-133 months). Retinal reattachment was obtained in all cases. Tumor thickness decreased in all cases and a completely flat scar was obtained in 65 patients (91.5%). Visual acuity was improved by two lines or more in 37 of the 71 patients (52%), and in 30 of the 40 patients (75%) treated within 6 months after onset of the first symptoms. The main radiation complications detected during follow-up were cataract (28%) and radiation-induced maculopathy (8%). None of the 71 patients developed eyelid sequelae or neovascular glaucoma., Conclusion: Proton beam irradiation with a total dose of 20 Cobalt Gray Equivalent appears to be a valid treatment for circumscribed choroidal hemangiomas, inducing definitive retinal reattachment and decreasing tumor thickness. However, delayed radiation-induced maculopathy may occur. A successful functional outcome is dependent on a short interval between onset of the first symptoms and initiation of therapy.