Rheumatic diseases are frequently complicated by extra-articular manifestations, often affecting the eye. Most of these ocular symptoms are benign and develop over long periods of time. Some ocular complications of rheumatic disease or the drugs used to treat the disease are rapidly sight-threatening. It is vital that sight-threatening complications are recognised quickly, so that appropriate diagnostic and therapeutic procedures, such as slit lamp examination and the initiation of immunosuppressive treatments, can occur in a timely fashion. Insight into the epidemiology, clinical presentation, common complications and treatment regimens of these ocular manifestations enables early detection and may prevent permanent loss of vision.