To determine the clinical outcome of patients treated with radiation therapy for periocular nonmelanoma skin cancer (NMSC). Eighty-six cases of periocular NMSC were treated with an accelerated radiation therapy schedule utilizing High Dose Electronic Brachytherapy. Patient selection was limited to age >40 years, and tumor size <40 mm in diameter and < 5 mm thick. Treatment sites included the upper or lower eyelids, medial or lateral canthus, or supra-orbital ridge in patients considered poor surgical candidates or who declined surgery. Demographics: Pathology: 82.6% basal, 17.4% squamous. Size by treatment field: 76.7% 10 mm, 19.8% 20 mm and 3.2% 35 mm. Location: 48.8% lower lid, 25.6% medial canthus, 23.3% upper lid, 2.3% lateral canthus. Age: 73.5 years median (40.8-99.6 years). Radiation therapy was administered per recommendations by ASTRO and AAPM and performed with a 50 kVx-ray device. All treatments were delivered within a single dermatology practice over a four-year period. A total of 4000 cGy in 500 cGy fractions were given twice weekly. Prescribed treatment depth was 0 mm for non-bulky disease. Bulky disease was debrided and/or treatment depth modified during treatment as necessary. Treatment interruptions were rare, usually due to infection or contact dermatitis and limited to less than two weeks. Ninety-nine percent of patients maintained a complete response at 2 years (0.2-3.7 years) median follow-up with one edge-of-field progression and no in-field recurrences. Transient low-grade conjunctivitis when using gold eye shields, minimal loss of eyelashes for treatment involving the ciliary rim. No long-term vision changes, dry eye, corneal injury, retinitis, dacrocystitis, orbital bone injury, or impairment of eyelid motion. Self-scored functional and cosmetic outcomes ranged from very good to excellent in 100% of patients. Radiation therapy utilizing High Dose Rate Electronic Brachytherapy offers a unique patient option for selected NMSC arising in the periocular space. When compared to multistage surgery, electronic brachytherapy results in improved patient comfort without the need for extended postoperative care or reconstruction. When compared to conventional radiation therapy, the high response rates, small field sizes, reduced treatment time, and lower radiation dose to adjacent critical tissues make electronic brachytherapy a useful addition to electron therapy or superficial x-ray (orthovoltage) techniques.