Systemic medications can give rise to ocular toxicity due to rich ocular blood supply and small ocular mass. These side effects can range from dry eye, keratitis, corneal deposits, glaucoma, cataract to blinding complications as a result of retinal toxicity and optic neuropathy. This review focuses on commonly used drugs, their ocular side effects, some newer drugs and their toxicity. Baseline examination and follow up at regular intervals is necessary for timely recognition of toxicity and discontinuation of these side effects. Recommendations for monitoring for medications with frequent and/or severe adverse ocular effects are discussed.