Purpose:No study has done yet to see the natural course of high homocysteine (HHcys) level following retinal vein occlusion (RVO).Hence our study tried to find out level of Hcys after 1 month of follow up among the RVO with HHcys at presentation. Material & Methods:A total of 37 patients with HHcys on the 2 nd day of presentation in RVO, were reevaluated for fasting plasma Hcys levels on 30 th day in their respective follow up in one year prospective case-control study.No intervention was done to reduce the HHcys during this period.Results: Hcys levels were increased significantly in the patients with RVO (mean total Hcys, 18.16 ± 4.73 μmol/L) as opposed to the control subjects (mean total Hcys, 11.05 ± 2.21 μmol/L; P < 0.001) on 2 nd day of presentation. One month follow up Hcys estimation revealed 22 patients with HHcys (mean total Hcys, 17.16 ± 4.13 μmol/L) and 15 patients with normal Hcys level (mean total Hcys, 11.76 ± 2.93 μmol/L).Conclusions: Elevated Hcys is not only a risk factor for RVO but also a marker of acute retinal vein occlusion hence routine therapy of Hcys lowering agents should be done judiciously in retinal vein occusion patients at presentation.