Background: Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. Early-onset neonatal sepsis, has been identified as a potential contributing factor to the incidence of ROP. Aim of the study: The aim of this study was to assess the incidence of retinopathy of prematurity in early onset neonatal sepsis. Methods: This cross-sectional study was conducted in Department of Ophthamology and Neonatal Intensive Care Unit (NICU), Dr. Sirajul Islam Medical College & Hospital Ltd., Dhaka, Bangladesh from June 2022 to July 2024. Total 300 preterm neonates with ROP were included in this study. Then, they were divided into two groups- group A: 150 patients with early onset neonatal sepsis and group B: 150 patients with late onset neonatal sepsis. Result: The mean gestational age in Group A was significantly lower (28.9 ± 2.3 weeks) than Group B (30.1 ± 2.2 weeks) (p < 0.01). Maternal infections were higher in Group A (50%). Oxygen therapy duration was longer in Group A (14 ± 3 days) than in Group B (10 ± 2 days) (p < 0.01). Group A had more cases of ROP (70% vs. 57%, p = 0.02). Risk factors for ROP included gestational age <28 weeks (OR = 2.10), oxygen therapy (OR = 1.60), and mechanical ventilation (OR = 1.45). Conclusion: This study concludes that neonates with early-onset neonatal sepsis had higher incidence and severity of ROP, with key risk factors being low gestational age, prolonged oxygen therapy, mechanical ventilation, and maternal infections.