Background This study was conducted to assess the correlation between various serum lipid profile components (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, VLDL cholesterol, and LDL:HDL cholesterol) and hypertensive retinopathy and its severity. Methods This was a hospital-based cross-sectional clinical study conducted among 100 hypertensive patients attending ophthalmic OPD. The study was undertaken at the Regional Eye Hospital, Kurnool, from November 2017 to October 2019 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results The prevalence of retinopathy increased with the duration of hypertension and showed a significant difference (p<0.0001). Hypertensive retinopathy showed a significant difference (p<0.001) between stages of hypertension. There was a significant difference between the retinopathy group and the non-retinopathy group in various lipid parameters like serum total cholesterol (p < 0.0001), LDL cholesterol (p < 0.0001), serum triglycerides (p = 0.0218) and LDL:HDL ratio (p = 0.0029). The various grades of retinopathy also showed statistically significant differences in various lipid parameters. Higher grades of retinopathy were associated with higher levels of serum total cholesterol (p = 0.035), LDL cholesterol (p = 0.028), serum triglycerides (p = 0.038), and LDL:HDL ratio (p = 0.021). Arcus senilis was higher in the retinopathy group than the non-retinopathy group. There was a significant difference between serum lipid parameters and hypertensive retinopathy (p = 0.045). This shows an association between serum lipid parameters and the prevalence of hypertensive retinopathy. Conclusion Lowering increased serum lipid parameters in hypertensive patients is advisable to preserve sight as well as prevent other end-organ damage.