Irrigated agriculture accounts for ∼90% of anthropogenic freshwater consumption, is deployed on 22% of cultivated land, and provides 40% of global food production. Expanding irrigation onto currently underperforming rainfed croplands is crucial to meet future global food demand without further agricultural expansion and associated encroachment of natural ecosystems. Establishing irrigation is also a potential climate adaptation solution to alleviate heat- and water-stress to crops and reduce climate variability and extremes. Despite irrigation being one of the land management practices with the largest environmental and hydroclimatic impacts, the role of irrigation to adapt agriculture to climate change and achieve global sustainability goals has just started to be quantified. This study reviews biophysical opportunities and feedbacks of ‘sustainable irrigation’. I describe the concept of sustainable irrigation expansion—where there are opportunities to increase agricultural productivity over currently water-limited rainfed croplands by adopting irrigation practices that do not deplete freshwater stocks and impair aquatic ecosystems. Expanding sustainable irrigation may avert agricultural expansion but create additional externalities that are often neglected. This review highlights major gaps in the analysis and understanding on the role of sustainable irrigation expansion to adapt agriculture to climate change. This study reviews the implications of a potential sustainable irrigation expansion on (a) global food security, (b) hydroclimatic conditions, (c) water quality, (d) soil salinization, (e) water storage infrastructure, and (f) energy use. These implications help to explain the challenges of achieving sustainability in irrigated agriculture and thus also point toward solutions and future research needs.