Background <p>To evaluate systemic inflammatory markers including the monocyte to high density lipoprotein cholesterol (HDL) ratio (MHR), neutrophil to HDL ratio (NHR), lymphocyte to HDL ratio (LHR), neutrophil to lymphocyte ratio (NLR), platelet to HDL ratio (PHR) in patients with keratoconus (KC). Correlations between these systemic markers and corneal topographic parameters were also investigated.</p> Methods <p>Retrospective analysis of peripheral blood sample results in patients with KC (n: 103) were performed. Mean MHR, NHR, LHR, NLR, and PHR were calculated in KC patients, and age and sex matched healthy controls (n:99). Corneal topography markers were also evaluated and correlations with systemic inflammatory markers were investigated.</p> Results <p>The mean PHR was significantly higher in KC group compared to control group (<i>p</i> = 0.004). Optimal PHR cut-off value for KC was calculated as 4807 with 74.8% sensitivity and 45.5% specificity. No significant correlation was found between corneal topograhy parameters and systemic inflammatory markers.</p> Conclusions <p>The mean PHR value was found to be higher in patients with keratoconus and no correlation was found between corneal topography findings and systemic inflammatory markers. This study is the first to explore HDL associated systemic inflammatory markers.</p>