This longitudinal study examined psychological well-being and social relations in school for six students with blindness or severe visual impairment (VI) in Swedish inclusive education. The students were followed through compulsory school, with data collection in Grades 1, 2, 3, and 9. A total of 151 interviews were conducted with the students, teachers, and parents during these years. At the end of ninth grade, the Strengths and Difficulties Questionnaire (SDQ) was also administered to all informants. The results revealed several challenges regarding social inclusion, with a majority of families being critical of the social situation in the schools. During lower school years, many examples of educational interventions aiming to facilitate social inclusion were described. However, as the children grew older, the parents’ and teachers’ possibilities to influence the group dynamics and create organized social arenas diminished drastically. Regarding the students’ general psychological well-being, the SDQ ratings showed minor or no differences compared to sighted norms. However, the interviews revealed that a majority of the students were stressed about school work and keeping up with their sighted peers and described feelings of loneliness. Some displayed emotional symptoms of which parents and teachers were not always aware. Three students had additional disabilities besides their VI. These students reported more overt psycho-social problems than the students with only VI. The students developed different strategies to handle the social challenges, for example, focusing on school work and getting good grades, or withdrawing and seeking friends with VI outside school. The conclusion is that students with visual impairments are a heterogeneous group comprising individuals with different needs, and that many of these students face social challenges in school. Interventions on different levels are necessary in order to improve the possibilities for these students’ social inclusion.