OBJECTIVE: Our objective was to compare maternal ophthalmic artery pulsatility index values in normotensive pregnancies and pregnancies complicated by hypertensive disorders. STUDY DESIGN: The ophthalmic artery in 17 normotensive nonpregnant women, 29 normotensive pregnant women, 9 patients with mild preeclampsia, 6 with severe preeclampsia, 6 with transient hypertension, and 9 with chronic hypertension was studied with color Doppler flow imaging and pulsed Doppler ultrasonography. The mean arterial blood pressure and the ophthalmic artery pulsatility index were calculated in each group. RESULTS: The pulsatility index (1.17 ± 0.08) in severe preeclampsia was lowest among the groupsp < 0.05), whereas that (2.92 ± 0.59) in normotensive pregnant women was highest among the groups(p < 0.05). The pulsatility index (1.47 ± 0.30) in mild preeclampsia was significantly lower than that (1.89 ± 0.27) in transient hypertension (p < 0.05). There was no significant difference in pulsatility index between mild preeclampsia and chronic hypertension (1.69 ± 0.49) or between transient hypertension and chronic hypertension. The pulsatility index inversely correlated well with the mean arterial blood pressure (R² = 0.645, p < 0.0001). CONCLUSIONS: These results suggest that the lower pulsatility index should be interpreted as orbital vascular vasodilation, indicating orbital hyperperfusion or hyperemia. Changes in pulsatility index in the ophthalmic artery may be indicative of similar changes in other cerebral vessels. (Am J Obstet Gynecol 1997;177:174-8)