Backround Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation. Methods Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality. Results There were statistically significant differences in the largest basal diameter of the tumor (t=-3.441), the tumor thickness (t=-4.140), the ciliary body infiltration (X-2=8.391), and the duration of follow-up (Z=3.995) between the two groups (P <0.05). The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis (RR=1.752, 95% CI 1.066-2.880, P=0.027), the largest basal diameter of the tumor (RR=3.508, 95% CI 1.934-6.336, P=0.000), and the histological type (RR=2.444, 95% Cl 1.106-5.877, P=0.046). The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation (X-2=1.214, P >0.05); the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation (X-2=1.304, P >0.05). The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 (92.60%) among persons retaining eye. Conclusions The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.