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The B vitamins are a varied family whose members are integral to metabolic pathways and cellular processes throughout the body. Unlike vitamins A, C, and E, the B complex has generally not been considered among the key ingredients of supplements intended to maintain eye health and prevent age-related disease and vision loss. This perspective may be shifting with the emergence of 3 elements: (1) a greater understanding of the pathogenic mechanisms involved in conditions such as age-related macular degeneration, diabetic retinopathy, glaucoma, cataracts, dry eye disease, and other ocular surface disorders; (2) observational studies linking B vitamins to risk of eye disease development or progression; and (3) preclinical and clinical evidence supporting supplementation with B vitamins to improve potential ocular outcomes. This review synthesizes the available data on the role of B vitamins in promoting healthy eye structure and function, highlighting connections between individual vitamins and disease, and discussing the clinical considerations for B vitamin supplementation.