Tea (Camellia sinensis L.) is the most widely consumed beverage in the world. It is mostly grown in the tropics with a heavy dependence on mineral nitrogen (N) fertilisers to maintain high yields while minimising the areas under cultivation. However, N is often applied in excess of crop requirements, resulting in substantial adverse environmental impacts. We conducted a systematic literature review, synthesising the findings from 48 studies to assess the impacts of excessive N application on soil health, and identify sustainable, alternative forms of N management. High N applications lead to soil acidification, N leaching to surface and groundwater, and the emission of greenhouse gases including nitrous oxide (N2O). We identified a range of alternative N management practices, the use of organic fertilisers, a mixture of organic and inorganic fertilisers, controlled release fertilisers, nitrification inhibitors and soil amendments including biochar. While many practices result in reduced N loading or mitigate some adverse impacts, major trade-offs include lower yields, and in some instances increased N2O emissions. Practices are also frequently trialled in isolation, meaning there may be a missed opportunity from assessing synergistic effects. Moreover, adoption rates of alternatives are low due to a lack of knowledge amongst farmers, and/or financial barriers. The use of site-specific management practices which incorporate local factors (for example climate, tea variety, irrigation requirements, site slope, and fertiliser type) are therefore recommended to improve sustainable N management practices in the long term.