Systemically administered medications have long been known to produce detectable ophthalmic signs. Some of these are benign, asymptomatic phenomena that do not require screening or regular follow-up, such as the vortex keratopathy characteristic of amiodarone use, but other medications are potentially toxic to the eye and can damage vision. Ocular toxicity is an established side-effect of several of the immunosuppressive medications in routine use in rheumatological disease, including hydroxychloroqine, but corticosteroids can also cause ocular side-effects in the form of cataract and raised intraocular pressure. Ocular side-effects often occur in a dose-related and reversible manner, but some toxicity reactions are idiosyncratic, irreversible or may progress despite cessation of treatment. © 2011 Bentham Science Publishers Ltd.