To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness during and after pregnancy in pregnant women with preeclampsia or eclampsia and compare it with normotensive pregnant women as controls. In a prospective comparative case-control study 35 women (70 eyes) with mild to moderate preeclampsia, 70 women (140 eyes) with severe preeclampsia and eclampsia, and 44 (88 eyes) healthy pregnant women were enrolled in three groups. Peripapillary RNFL thickness in three groups was measured after 28weeks of pregnancy and 2months postpartum by using optical coherence tomography. Mean and quadratic RNFL thickness changes were compared within and among the groups. Mean peripapillary RNFL thickness decreased significantly from 104±10, 104±23, and 106±9µm during pregnancy to 101±10, 96±10, and 103±9µm 2months after pregnancy in the mild to moderate preeclampsia, severe preeclampsia and eclampsia, and healthy pregnant women groups, respectively (P<0.001 for all). While the difference among the groups was insignificant during pregnancy, it reached to a significant level after delivery (P=0.006). The highest reduction in mean RNFL thickness (6±10µm) occurred in the severe preeclampsia and eclampsia groups. In relation to the time of pregnancy, peripapillary RNFL reduced in preeclamptic and eclamptic cases as well as in normotensive pregnant women at 2months postpartum. This reduction was more in the severe forms of pregnancy-induced hypertension.