Background: In comparison to smaller ones, larger platelets indicate altered reactivity and aggregation. Mean platelet volume (MPV), knowingly used to assess the size, is significantly elevated in hypertension. High MPV is equivalent to a high risk of thrombotic events. Retinal vein occlusion (RVO) is one of the most common extracardiac complications of hypertension, which may lead to vision loss. Assessment of MPV may help to determine the development of the disease. Objective: We aimed to analyze if elevated MPV was associated with the incident of RVO, particularly in hypertensive patients. Method: A literature search was conducted through PubMed, Cochrane, and Science Direct for primary studies. The abstracts and full text were scanned for potentially relevant articles that fulfilled the inclusion criteria. The quality assessment was done using the Newcastle-Ottawa Quality Assessment Scale (NOS) for case-control studies. We analyzed the data using STATA 14.1. Result: Four studies (363 RVO patients and 256 controls) were incorporated into this meta-analysis. Due to the high heterogeneity, a random-effects model was used to calculate the pooled SMD and corresponding 95% confidence intervals. Results have indicated significant increase of MPV levels (SMD = 1.008, 95% CI 0.819–1.197, P < 0.001) and insignificant increase of platelet count levels (SMD = 0.149, 95% CI 0.016–0.313, P = 0.076) in hypertensive patients with RVO compared to controls. Conclusion: We found that MPV is strongly associated with the presence of RVO in hypertensive patients. Further studies are required to ascertain the potential clinical use of this simple and relatively inexpensive marker in RVO diagnosis.