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Background: Visual involvement is the most feared complication of giant cell arteritis (GCA). Information on the efficacy of tocilizumab (TCZ) for this complication is scarce and controversial., Objective: We assessed a wide series of GCA treated with TCZ, to evaluate its role in the prevention of new visual complications and its efficacy when this manifestation was already present before the initiation of TCZ., Design: This is an observational multicenter study of patients with GCA treated with TCZ., Methods: Patients were divided into two subgroups according to the presence or absence of visual involvement before TCZ onset. Visual manifestations were classified into the following categories: transient visual loss (TVL), permanent visual loss (PVL), diplopia, and blurred vision., Results: Four hundred seventy-one GCA patients (mean age, 74 ± 9 years) were treated with TCZ. Visual manifestations were observed in 122 cases (26%), of which 81 were present at TCZ onset: PVL ( n  = 60; unilateral/bilateral: 48/12), TVL ( n  = 17; unilateral/bilateral: 11/6), diplopia ( n  = 2), and blurred vision ( n  = 2). None of the patients without previous visual involvement or with TVL had new episodes after initiation of TCZ, while only 11 out of 60 (18%) patients with PVL experienced some improvement. The two patients with diplopia and one of the two patients with blurred vision improved., Conclusion: TCZ may have a protective effect against the development of visual complications or new episodes of TVL in GCA. However, once PVL was established, only a few patients improved., Competing Interests: Competing interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Disclosures that might be interpreted as constituting of possible conflict(s) of interest for the study: J. Loricera had consultation fees/participation in company-sponsored speaker’s bureau from Roche, Novartis, UCB Pharma, MSD, Celgene, and Grünenthal and received support for attending meetings and/or travel from Janssen, AbbVie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer, Galápagos. S. Castañeda is assistant professor of the UAM-Roche, EPID-Future chair, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain, and received support for attending meetings and/or travel from Janssen, AbbVie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer. V. Aldasoro had consultation fees/participation in company sponsored speaker’s bureau from Janssen, BMS, MSD, Roche, Sanofi, Pfizer, Novartis, Amgen, Lilly, AbbVie, Gebro, Nordic, Lacer, Alter, UCB, ASAC Pharma, Menarini and Celgene and received support for attending meetings and/or travel from Janssen, BMS, MSD, Roche, Sanofi, Pfizer, Novartis, Amgen, Lilly, AbbVie, Gebro, Nordic, Lacer, Alter, UCB, ASAC Pharma, Menarini, and Celgene. O. Maiz received support for attending meetings and/or travel from Janssen, AbbVie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer. P. Vela received grants/research supports from AbbVie, Pfizer, BMS, Novartis, MSD, and Roche and had consultation fees/participation in company sponsored speaker’s bureau from Pfizer, BMS, Lilly, UCB, and MSD and received support for attending meetings and/or travel from Pfizer, BMS, Lilly, UCB, and MSD. S. Romero-Yuste had consultation fees/participation in company sponsored speaker’s bureau from AbbVie, Astra-Zeneca, BMS, Fresenius, Janssen, K. Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Rubió, Sandoz, Sanofi, UCB and attendance at conferences AbbVie, Astra-Zeneca, BMS, Fresenius, Janssen, K. Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Rubió, Sandoz, Sanofi, UCB. E. de Miguel had consultation fees/participation in company sponsored speaker’s bureau from AbbVie, Novartis, Pfizer, BMS, MSD, UCB, Roche, Grünenthal, and Janssen and received support for attending meetings and/or travel from AbbVie, Novartis, Pfizer, BMS, MSD, UCB, Roche, Grünenthal, and Janssen. E. Galíndez-Agirregoikoa had consultation fees/participation in company sponsored speaker’s bureau from Celgene, AbbVie, Pfizer, Roche, Lilly, MSD, Janssen, and Bristol and received support for attending meetings and/or travel from Celgene, AbbVie, Pfizer, Roche, Lilly, MSD, Janssen, and Bristol. F. Sivera received grants from Roche. Iván Ferraz-Amaro received grants/research supports from AbbVie, MSD, Janssen, and Roche and received consultation fees from company-sponsored speaker’s bureau associated with AbbVie, Pfizer, Roche, Sanofi, Sobi, Amgen, Celgene, and MSD and received support for attending meetings and/or travel from AbbVie, Pfizer, Roche, Sanofi, Sobi, Amgen, Celgene, and MSD. Mónica Calderón-Goercke received support for attending meetings and/or travel from Lilly, AbbVie, Pfizer. José L. Hernández received grants from Amgen and had participation in company-sponsored speaker’s bureau from Amgen, MSD, Bayer, and Esteve. Miguel A. Gonzalez-Gay has received grants/research supports from AbbVie, MSD, Janssen, and Roche and had consultation fees/participation in company-sponsored speaker’s bureau from AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene, and MSD and received support for attending meetings and/or travel from AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene, and MSD. R. Blanco received grants/research supports from AbbVie, MSD, and Roche, and had consultation fees/participation in company-sponsored speaker’s bureau from AbbVie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD and received support for attending meetings and/or travel from AbbVie, Pfizer, Roche, Bristol-Myers, Lilly, Janssen, and MSD. The other co-authors have declared no competing interests., (© The Author(s), 2022.)