Background: The objectives of the study were to find the incidence of retinopathy of prematurity and risk factors associated with its development. Methods: Observational study was carried out at tertiary care hospital. Inclusion criteria: All hospitalized preterm infants with birth weight <1.5 Kg and gestational age ≤32 weeks. Selected preterm 1.5 to ≤2 Kg and gestational age >32 to ≤37 week, with additional risk factors (neonatal & maternal). Results: The overall incidence of ROP in present study was 21.87%. Of these 14.28% had stage І, 64.28% had stage ІІ ROP and 21.42% had plus disease. ROP was bilateral in all 14 neonates. The incidence was high in ELBW (100%), in the gestational age group 28-30 weeks (61.53%). Among the neonatal risk factors, oxygen therapy was a significant risk factor and chances of developing ROP were increased as duration of oxygen therapy increased (>72 hr) (p=0.0005). Episodes of hyperoxia, >3 episodes (p=0.0002) and hypoxia with 2-3 episodes, (p=0.008) were associated with development of ROP. Acidosis, (p=0.006), NEC (p=0.00002), proven sepsis (p=0.002), hyperbilirubinemia requiring intensive phototherapy (p=0.002), PDA (p=0.0007) and partial parenteral nutrition (p=0.02) were other risk factors associated. Mean NICU stay was longer in patients with ROP (p=0.001). Stage 1 and 2 ROP without plus disease showed spontaneous regression (100%) on follow up. Overall incidence of babies requiring laser treatment was 14.28%. Conclusions: We should screen all preterm with birth weight <1500 g and gestational age ≤32 weeks, irrespective of risk factors and babies between 1.5 to 2 kg and between 32 and 37 weeks, having risk factors for ROP.