**Inclusion criteria** - Observational studies of the environmental impact of eye health care provision (quantified as carbon dioxide equivalent or other measure of greenhouse gas (GHG) emission, air or water toxins or other pollutants) - Interventional studies investigating strategies to diminish the environmental impact of eye health care provision - Systematic literature reviews or modelling exercises that explore either negative environmental impact of eye health care or interventions to mitigate environmental impact of health care which report eye care specifics **Exclusion criteria** - Studies of waste (eg wasting water in surgical scrub or wasting drugs) which do not directly or indirectly evaluate the environmental impact of the waste - Studies that increase productivity for the same resource utilisation but do not quantify the environmental costs per unit activity - Editorials or other articles which do not report any primary data **Information Sources and Search Strategies** On 11 March 2020 a Cochrane Eyes and Vision Information Specialist (IG) conducted searches in MEDLINE, Embase and Global Health databases. The search strategy for MEDLINE is included in Appendix 1. No time period, language, or geographic limits were applied. Both interventional and observational studies were included that evaluate the impact of eye health care delivery or manufacturing of related products on the environment, either directly or through surrogate end points such as energy. Reference lists of all included articles were examined to identify further potentially relevant studies. **Selection of sources of evidence** Covidence systematic review software was used for screening (Veritas Health Innovation, Melbourne, Australia). Each title and abstract were screened independently by two reviewers to exclude publications that clearly did not meet the inclusion criteria. Subsequently, the full text articles were retrieved for review if the citation seemed potentially relevant. Two reviewers independently assessed each article against the inclusion and exclusion criteria. Any discrepancies between the reviewers were resolved by a third reviewer with access to comments from other investigators. **Data Charting** A spreadsheet for data importation was designed and reviewed by all investigators after initial importation of results from the first identified included paper. Data recorded for each publication included title, year of publication, study design, country of origin (defined as the country in which the institution of the first author is located) and World Bank income level of that country, primary outcome measure, means of quantification of environmental impact, statistical analysis of primary outcome and other results of note. Study details were extracted by two independent investigators for all included studies. Results were thematically analysed and reported; no opportunity for meta-analysis presented itself.