BACKGROUND: Ocular tumours, regardless of type, impose significant economic and psychosocial burdens on sufferers and their families [1]. Paediatric cases can lead to substantial challenges, including developmental delays, economic strain, and psychological distress. The aim of this study was to determine the prevalence and presentation of ocular tumours among children in Malawi. METHOD: The study was designed as a hospital-based cross-sectional retrospective review of paediatric files obtained from the Ophthalmology Department of the four tertiary hospitals (Kamuzu, Queen Elizabeth, Mzuzu and Zomba Central Hospitals) in Malawi from 2009 to 2019. Data was analysed using the Statistical Package for the Social Sciences version 26.0 for data analysis. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 1,014 out of 40,423 children were diagnosed with ocular tumours representing an overall prevalence of 2.51% (CI: 2.36-2.67). Among them, 485 were females (47.8%) and 529 males (52.2%), which was not statistically significant (p = 0.426). Most (46.1%) of the cases were from the Queen Elizabeth Central hospital with most cases recorded in 2019. Patients aged 3-5 years had the most cases of ocular tumours. Retinoblastoma was the most prevalent malignant tumour (41.6%), while dermoid cysts was the most common (20.7%) benign tumour. Tumours were more frequently found in the left eye (51.1%) compared to the right eye (43.8%), with 5.1% involving both eyes. The proportion difference in laterality between the right and left eye was statistically significant (p = 0.012). Imaging was performed in 10.0% of cases, with MRI being the most common (6.5%), followed by B-scan (2.4%), CT-scan (0.9%), among others. Surgical procedures were performed in 80.4% of cases, with excision being the most common (47.3%), followed by enucleation (27.2%), and exenteration (4.2%). CONCLUSION: The study observed a high prevalence of ocular malignancies with children aged 3 to 5 years being the most affected age group. Surgical excision was the main stay of treatment for children affected by ocular tumours in Malawi. Poor diagnostic and therapeutic options remain a big limitations to the provision of care for this population as such there is an urgent need to improve paediatric oncology services in Malawi. Policymakers and healthcare providers must prioritize investments in diagnostic infrastructure, training, and integrated care pathways to enhance the management of paediatric ocular tumours and improve survival rates.