Strong gravitational lensing is a competitive tool to probe the dark matter and energy content of the Universe. However, significant uncertainties can arise from the choice of lens model, and in particular the parameterisation of the line of sight. In this work, we consider the consequences of ignoring the contribution of foreground perturbers in lens modelling. We derive the explicit form of the degeneracy between the foreground shear and the ellipticity of a power law lens, which renders the former quantity effectively unmeasurable from strong lensing observables, and biases measurements of the latter by a few percent. Nonetheless, we demonstrate that this degeneracy does not affect measurements of the Einstein radius. Foreground tidal effects are also not expected to bias the slope of the potential, and any biases in this slope should not affect the recovery of the Hubble constant. The foreground convergence term adds an additional uncertainty to the measurement of H 0, and we show that this uncertainty will be on the order of 1% for lensing systems located along random lines of sight. There is evidence to indicate that the probability of strong lensing is higher towards overdense lines of sight, and this could result in a small systematic bias towards overestimations of H 0.