BackgroundTwo leading hypotheses for restless legs syndrome (RLS) pathophysiology are dopaminergic dysfunction and sympathetic overactivity. Ocular changes occur with both dopaminergic and sympathetic pathologies, and thus may provide unique insights into the pathophysiology of RLS. MethodsThirty-five patients with RLS and 35 healthy individuals were enrolled in the study. Peripapillary retinal nerve fiber layer (RNFL), macular, and choroidal thicknesses were measured by optical coherence tomography (OCT). ResultsThere were no statistically significant differences between the two groups regarding RNFL and macular thicknesses. The subfoveal, temporal and nasal choroidal thicknesses were significantly thinner in patients with RLS compared with normal subjects (p < 0.05). ConclusionThinning of the choroid is linked to sympathetic overactivity. Our results provide further evidence for sympathetic overactivity in the pathogenesis of RLS.