The impact of sedimentation on coral–algal interactions was studied by monitoring tissue mortality and radial growth in two coral species, Colpophyllia natans and Siderastrea siderea, over a continuum of sediment input intensities. This study sets out to investigate (1) whether sedimentation can facilitate algal overgrowth of corals and (2) whether this was a significant cause of coral mortality. Over a 15-month period, 198 coral colonies were tagged and photographed at six sites along two replicate gradients of sediment input, spanning high inputs near river mouths to low inputs at exposed headlands. Photographs were taken so that they covered the interface between colonies and algae. Radial growth was measured along colony edges in contact with algae and unaffected by tissue loss from causes other than competition with algae. To establish whether algal overgrowth was a significant cause of coral mortality, tissue mortality on the colony surface area visible in the photographs was related to different causes, including sediment smothering, disease, and algal overgrowth. Radial growth became negative with increasing proximity to river mouths in C. natans and remained negative or close to zero throughout the gradients in S. siderea, overall suggesting that sedimentation can facilitate algal overgrowth on corals. However, the analysis of tissue mortality revealed that algal overgrowth was a relatively minor cause of tissue loss. In contrast, the most important cause of coral mortality in relation to sedimentation was from sediment smothering, probably during intense episodes of deposition associated with heavy rainfall. We conclude that sedimentation may lead to reef degradation by causing coral mortality through sediment smothering and burial, and then by suppressing the regrowth of surviving adult colonies through increased competition with algae.