BACKGROUND Sickle cell disease is an autosomal recessive hemoglobinopathy caused by a defect in the beta chain of hemoglobin, which results in a chronic hemolytic anemia affecting multiple organs. Its ocular effects have been found in the adnexae, anterior and posterior segments. Sickle cell disease is a public health issue which can be associated with significant ocular and systemic morbidity that could lead to blindness and death especially in sub-Saharan Africa. Foetal hemoglobin is one of the genetic modifiers which ameliorate severity of the disease. Several studies worldwide have shown improvement in systemic severity with elevated foetal hemoglobin levels. There is a paucity of studies showing a similar trend with the ocular manifestations of the disease. AIM: To determine the prevalence and pattern of ocular manifestations and their relationship with foetal hemoglobin levels among adult sickle cell disease patients, at the University of Port Harcourt Teaching Hospital, Rivers state.