Purpose <p>Purpose of study-Pre-eclampsia is a leading cause of maternal mortality, with 12% of deaths being attributed to this condition and its complications.The neurological sequelae of pre-eclampsia are related to cerebrovascular endothelial dysfunction. Ocular circulation reflects the status of cerebral circulation as the ophthalmic artery has embryological, anatomic and functional similarities to CNS arteriolar vessels.</p> Objective <p>To evaluate the changes in ophthalmic artery Doppler parameter, Peak ratio in women with pre-eclampsia as compared to normotensive women and to examine its association with pregnancy outcome in pre eclamptic women.</p> Methods <p>This was a prospective cohort study conducted at a tertiary care center, over a period of one year involving preeclamptic and normotensive women. Opthalmic artery Doppler was performed in all recruited women. All pre-eclamptic women were followed till discharge for maternal and fetal outcomes.</p> Result <p>222 women were recruited out of which 111 were pre eclamptic and 111 were normotensive. Peak ratio cut off was calculated as 0.85 by plotting a receiver operator curve. 88.1% of pre eclamptic women with higher peak ratio i.e. &gt; 0.85 had adverse maternal outcomes whereas 51.9% pre-eclamptic women with peak ratio &lt; 0.815 had adverse outcomes.</p> Conclusion <p>Ophthalmic artery Doppler could serve as a cost effective, non invasive readily applicable and reproducible marker to predict adverse maternal outcome in pre eclamptic women,thus identifying risk for neurological complications in pre eclamptic women, thereby allowing for appropriate targeted therapy.</p>