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To report risk factors for decreased visual acuity in patients with chronic graft-versus-host disease (cGVHD) diagnosed after hematopoietic cell transplantation (HCT) and to describe the prevalence of anterior segment findings in these patients.Retrospective noncomparative study of 429 consecutive patients with cGVHD. Outcome measures include visual acuity, Schirmer scores, and ocular surface abnormalities.Of 429 patients, 422 (98.4%) with cGVHD had visual acuity of ≥20/40 in at least 1 eye at the initial evaluation, with 96.5% of patients retaining visual acuity of 20/40 or better at the last follow-up. Ocular surface abnormalities reported in patients with cGVHD included conjunctival hyperemia in 10.5% and chemosis in 3.0%. Pseudomembranous conjunctivitis, symblepharon, conjunctival subepithelial fibrosis, and corneal epithelial sloughing were uncommon. Ocular surface disease commonly persisted at the last documented ophthalmic examination, with corneal epithelial staining noted in 33.6% of patients and keratoconjunctivitis sicca in 53.4%. Cataracts were observed in 39.4% and were associated with a 4-fold risk (P = 0.023) of visual acuity 20/50 or worse in patients with cGVHD.Nearly all patients with cGVHD retained excellent visual acuity despite the high prevalence of aqueous tear deficiency and corneal staining. Limitation in visual acuity in this patient population was most often associated with cataract formation. Conjunctival findings are not uncommon findings in cGVHD, and future studies are necessary to determine if advanced-stage conjunctival involvement with pseudomembranous conjunctivitis may be associated with extensive systemic GVHD and poorer posttransplant survival.