This review examines the current treatment landscape for uveal melanoma, highlighting effective local therapies such as enucleation and plaque brachytherapy. Despite advances in medical therapeutics, the outcome for metastatic uveal melanoma has not improved significantly in the past 50 years, with immune checkpoint inhibitors showing limited success. The review discusses the role of local therapies and examines various treatment options for uveal melanoma, ranging from conventional chemotherapy and checkpoint inhibitors to newer molecularly selective T-cell therapies. Additionally, emerging strategies such as biomarker-driven patient stratification and multimodal therapies, including inhibition of the mitogen-activated extracellular signal-regulated kinase (MEK) pathway, histone deacetylase (HDAC) inhibitors, and spliceosome-targeted treatments such as splicing factor 3b subunit 1 (SF3B1) inhibitors, are discussed as potential avenues to improve patient outcomes.