Objective External distraction appears to affect at least 6–9% of distraction-affected motor vehicle collisions. Billboards may be good models for studying external distraction in general, and it is also desirable to understand billboard-related distraction per se. However, there has not yet been a clear consensus on the scope of billboard-related distraction or its dynamics with respect to characteristics of drivers, billboards, traffic, and the roadway. To narrow these knowledge gaps, a systematic literature review was conducted on billboard-related changes in driver visual behavior. Methods A systematic literature search yielded 443 results, of which 8 studies met all inclusion criteria. Five studies meeting all inclusion criteria were later identified and added. Results were analyzed in terms of 4 categories of visual behavior: (1) gaze variability (GV), glance pattern activity (GPA), and percentage of time spent glancing at the forward roadway; (2) glances at unexpected drive-relevant stimuli; (3) glances at expected drive-relevant stimuli; and (4) glances at billboards. Results There was considerable evidence that about 10–20% of all glances at billboards were ≥0.75 s, that active billboards drew more glances and more long glances (≥0.75 s, ≥2.0 s) than passive billboards but did not attract a longer average glance, and that there was large variability among individual billboards within categories (e.g., active vs. passive). The extent to which billboards attracted glances ≥ 2.0 s was uncertain. There was tentative evidence that billboards did not affect GPA, glances at expected drive-relevant stimuli, or the proportion of time drivers spent glancing at the forward roadway and that they did affect vertical GV and glances at unexpected drive-relevant stimuli. Conclusions Generally, billboard-related distraction appeared to be minor and regulated by drivers as the demands of the driving task changed. However, this review’s findings suggest that this may not be true in all cases. Future research should emphasize the tails of the distribution in addition to average cases, in terms of both the analysis of visual behavior and the complexity of driving tasks. Further research is also needed to understand the effects of billboard design, driver characteristics, and road and traffic context.