Ankylosing spondylitis, a form of axial spondyloarthritis (SpA), is a chronic inflammatory rheumatic disease and manifests itself by inflammatory back pain, radiographic sacroiliitis, and excess spinal bone formation, as well as non-skeletal manifestations such as uveitis, inflammatory bowel disease (IBD), or psoriasis 1 . Reported prevalence rates range between 0.1 and 0.5% 1,2 .Tumor necrosis factor-alpha (TNF-alpha) is a cytokine with a key regulatory role in the inflammatory response, and impaired regulation of TNF-alpha has been suggested to have a role in the pathogenesis of inflammatory conditions. Blocking the action of TNF-alpha has been used in the treatment of chronic inflammatory conditions, including ankylosing spondylitis. Adalimumab is a recombinant human IgG1 monoclonal antibody, specific for human TNF-alpha.Despite its revolutionary benefits in rheumatologic disease, adverse effects such as ocular complications, severe infection, demyelinating conditions, malignancies, a lupus-like syndrome, induction of autoantibodies, injection site reactions, and heart failure have been reported with the use of TNF-alpha inhibitors 3 . Reported ocular side effects include periorbital infection, oculomotor nerve palsy, optic neuritis, central vein occlusion, as well as a paradoxical adverse event uveitis [4][5][6][7][8] . Most data on ocular side effects come from anecdotal reports, and pathophysiological processes are mostly unknown³; thus, ocular structural changes during long-term TNF-alpha inhibitor use may shed light on the pathogenesis of these conditions.Optical coherence tomography (OCT) is a practical technique widely used in clinical practice, which enables detailed examination of the eye and allows the thicknesses of the choroid, retina, and peripapillary retinal nerve fiber layer (RNFL) to be measured.