Fibromyalgia is a chronic, widespread pain syndrome, with unclear etiology, characterized by fatigue, sleeping problems, cognitive disorders, somatic complaints and severe pain in tender points of the body at the time of physical activity with no laboratory findings to the disease and diagnostic tests. Fibromyalgia can be associated with ocular symptoms (foreign body sensation, irritation) and visual disturbances (blurred vision), coexisting with dry eye syndrome (DES) and reduced corneal sensitivity. Cases of scleritis, including the necrotizing form, accompanying fibromyalgia have been reported. Ocular changes in the eyeball can contribute to the pathogenesis of fibromyalgia. Research shows the choroid to be significantly thinner in patients with fibromyalgia, revealing optic disc perfusion and a decreased retinal nerve fiber layer (RNFL) thickness and thin corneal stromal nerves with diminished sub-basal plexus nerve density. The pathology and functional abnormalities of small nerve ﬁbers were observed in patients with fibromyalgia. Corneal confocal bio-microscopy is a new noninvasive method to evaluate small nerve fiber morphology, as an alternative for skin biopsies and reveals new possibilities in diagnostics and finding innovative therapies for this disease. Fibromyalgia remains a challenge for ophthalmologists and further studies are required to evaluate eye involvement. It may be that future diagnostic criteria for fibromyalgia will contain ophthalmic examination modalities. Observed ocular changes and their pathomechanisms may constitute new targets for therapy to improve the quality of life of fibromyalgia patients.Copyright © 2020 Elsevier Inc. All rights reserved.