Visually coupled systems such as helmet mounted displays are designed to improve aircrew situational awareness by providing timely flight, targeting and other information overlaid on real or sensor-derived views of the external environment. Data can be presented in monocular, biocular or binocular fashion and are associated with visual conflicts and potential ophthalmic problems. Restricted sensor spectrum, limits of resolution, inherent system latency, the displaced visual input from remote sensors and restricted field of view may contribute to ophthalmic symptoms in aircrew. Disruption to binocularity and reliance on monocular cues for depth perception and hyperstereopsis from sensor-induced convergence disparity may cause distance estimation problems, whereas inappropriate accommodative stimuli and ocular dominance factors are common causes of eyestrain. Binocular rivalry from discordant imagery to each eye may compromise visual performance via several mechanisms. This article discusses the potential visual problems associated with visually coupled systems and the challenges of integrating complex systems with the aircrew interface.