The ideal treatment in any type of cancer is curative. Unfortunately, this is not yet an achievable goal with breast cancer. Therefore, the available treatment should aim to prolong life without diminishing the quality of life. Tamoxifen has been the most widely used endocrine therapy in the past 30 years for the treatment of metastatic breast cancer (Buzdar 2001). The incidence of side effects is low but ocular adverse reactions (OARs) have been regularly reported for this drug. The aim of this review is to look briefly at the development of tamoxifen from the early laboratory studies to the present-day use in treatment of breast cancer. The OARs associated with tamoxifen will be discussed and related to the clinical findings in practice. New drugs in development for the endocrine treatment of the disease will be briefly compared to tamoxifen.