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18 ± 0.23mm, p 0.0005. ONSD persisting more than 4.6mm by 24h of management predicted poor outcome with sensitivity and specificity of 83.3% and 72.7%. ONSD is a simple, bedside, inexpensive, reproducible and repeatable modality to assess ongoing change in ICP in PALF. ONSD more than 4.55mm suggests raised ICP. The goal should be to bring ONSD down to less than 4.6mm within 24h by aggressive anti-ICP therapy to achieve favourable outcome. ONSD is a simple, bedside, inexpensive, reproducible and repeatable modality to assess ongoin