This paper reviews and evaluates the current state of knowledge on the direct effects of terrestrial runoff on (1) the growth and survival of hard coral colonies, (2) coral reproduction and recruitment, and (3) organisms that interact with coral populations (coralline algae, bioeroders, macroalgae and heterotrophic filter feeders as space competitors, pathogens, and coral predators). The responses of each of these groups are evaluated separately against the four main water quality parameters: (1) increased dissolved inorganic nutrients, (2) enrichment with particulate organic matter, (3) light reduction from turbidity and (4) increased sedimentation. This separation facilitates disentangling and understanding the mechanisms leading to changes in the field, where many contaminants and many responses co-occur. The review also summarises geographic and biological factors that determine local and regional levels of resistance and resilience to degradation. It provides a conceptual aid to assess the kind of change(s) likely to occur in response to changing coastal water quality.