We performed a prospective, controlled, masked study designed to evaluate the ocular manifestations of preeclampsia in 56 patients, including 25 control, 17 mild preeclamptic, and 14 severe preeclamptic patients. There was a statistically significant correlation between the reduction in arteriole to vein ratio and a diagnosis of severe preeclampsia (r = -.32, P = .004). There was also a significant correlation between the number of focal constrictions and a diagnosis of severe preeclampsia (r = .34, P = .005). The arteriole to vein ratio and number of focal constrictions did not differ significantly between normal and mild preeclamptic patients. None of the patients showed background changes of hemorrhages, cotton-wool spots, and exudates, or evidence of choroidal ischemia (including Elschnig's spots and retinal detachment). In contrast to previous reports, the role of the ophthalmologist in the diagnosis and management of preeclampsia appears to be limited.