AbstractAimsTo investigate whether there is a relationship between intraocular pressure (IOP) and diabetic retinopathy.MethodsRetrospective analysis of a retinal screening database of 5838 patients with diabetes compiled over 5 years giving information on 20 091 eye examinations.ResultsLower mean IOP was associated with the presence of hard exudates alone (p < 0.005) and hard exudates with cotton wool spots (p < 0.001). There was no statistically significant association between IOP and other grades of retinopathy.ConclusionsThe mean IOP reductions observed in exudative retinopathy, although statistically significant, were probably too small to measure conventionally. The effect of low IOP on development of retinopathy may be mediated by higher ocular perfusion pressure, but why this would be specific to exudative disease is unclear. Copyright © 2002 John Wiley & Sons, Ltd.