Background <p>This study aimed to determine whether cardiovascular conditions, specifically atrial fibrillation (AF) and congestive heart failure (CHF), are associated with detectable alterations in anterior segment morphology via Scheimpflug-based corneal tomography (Pentacam^®, Oculus, Germany).</p> Methods <p>A total of 120 eyes from 120 participants were included in this cross-sectional study. The subjects were categorized into four groups: AF, CHF, AF + CHF, and age- and sex-matched healthy controls (<i>n</i> = 30 per group). All participants underwent a comprehensive ophthalmic evaluation, including Pentacam imaging. The quantitative analyses included keratometric parameters, corneal pachymetry profiles, anterior chamber metrics, pupil diameter, and indices of corneal surface irregularity.</p> Results <p>The groups were comparable in terms of age and sex (<i>p</i> &gt; 0.05). No significant intergroup differences emerged in keratometric values, corneal thickness, or anterior chamber metrics, though astigmatism trended lower in the AF + CHF group. Among the irregularity indices, only the keratoconus index (KI) demonstrated an overall group effect (<i>p</i> = 0.049), but post hoc comparisons failed to confirm significance.</p> Conclusions <p>Scheimpflug-based tomography revealed largely preserved anterior segment characteristics in individuals with AF and/or CHF. The minor variation observed in the KI may reflect subtle corneal surface irregularities potentially associated with systemic cardiovascular pathology, highlighting the need for larger, longitudinal studies to clarify these findings.</p>