To ascertain the ophthalmic complications after heart transplantation, the authors reviewed 59 patients who had been referred to the ophthalmology department during a 4-year period and were subsequently followed for at least 1 year. Twenty-five patients (43%) were found to have lens changes in one or both eyes, which is typical of prolonged oral corticosteroid therapy. In three patients (5.2%) posterior subcapsular cataract formation progressed to a level where cataract surgery was required. In two patients (3.4%) cytomegalovirus retinitis developed within 6 months of the transplantation, and significant irreversible visual loss occurred. Retinal vascular changes were found in 22 patients (37.3%), including 18 patients with hypertensive retinopathy and one patient with background diabetic retinopathy. During the period of observation, a central retinal vein occlusion developed in one patient, an anterior ischemic optic neuropathy developed in one patient, and bilateral occipital lobe infarctions developed in one patient. Older patients and those with a longer survival time after transplantation were more likely to have ophthalmic complications (p = 0.04). Although these results indicate a low incidence of sight-threatening complications after heart transplantation, early referral of patients with visual symptoms is important. Those involved with the care of heart transplant patients should be aware of ocular complications secondary to immune suppression and underlying cardiovascular disease.