Purpose: To determine the prevalence of Pathological Myopia among patients attending Kasr ElAiny outpatient ophthalmology clinic and to determine the prevalence of retinal manifestations present among them. Methods: This study was a 2 phase cross-sectional study. In phase 1, the prevalence of high myopia was determined. It included 1289 eyes of 668 patients (ages 14-84 years). These eyes underwent full ophthalmological examination as well as non-cycloplegic refraction or A scan ultrasonography if refraction was not possible. Eyes found to be highly myopic, defined as refraction more than or equal to -6D spherical equivalent and/or have an axial length more than or equal to 25.5 mm, were recorded to determine the prevalence and entered phase 2 of the study. In phase 2, the prevalence of retinal manifestations among highly myopic eyes found in phase 1 was determined. Of the 140 identified highly myopic eyes, 127 eyes underwent fundus examination; optical coherence tomography, fundus photography and A scan and B scan ultrasonography. Manifestations present were recorded for each eye and the prevalence of each manifestation was determined. Results: Our study showed that the prevalence of highly myopic eyes was 10.9% in Kasr ElAiny outpatient ophthalmology clinic of our department. Regarding patients with highly myopic eyes, 22.6% had unilateral high myopia, while 77.4% had bilateral high myopia. The most prevalent retinal manifestation in our study was peripheral retinal lesions that were found in 63.8% of examined eyes, followed by tigroid fundus, found in 59.1% of eyes. Peripheral lesions were significantly associated with more myopia (p = 0.02) and a longer axial length (p = 0.046). The commonest peripheral lesion was white without pressure, found in 37.8% of eyes. It was significantly associated with a younger age (36.8 ± 15.6 years, p = 0.002). Lattice degeneration was found in 11.8% and snail track degeneration in 4.7%. They were not significantly associated with age, degree of myopia, axial length or retinal detachment. Macular holes were present in 4.7% of eyes and 60% of eyes with FTMH had a retinal detachment. Foveoschisis was present in 5.5% of eyes and was significantly associated with an older age (p = 0.012), a longer axial length (p = 0.010), more myopia (p = 0.002) and patchy chorioretinal atrophy (0.024). Retinal detachment was present in 6.3% of eyes. Retinal breaks were found in 4.7% of eyes. Posterior staphyloma was present in 33.1%. It was found that the higher the myopia of the patient the higher the odds to have posterior staphyloma. Lacquer cracks and CNV were present in 6.3% of eyes. Both were significantly associated with more myopia and a longer axial length, but only CNV was significantly associated with age. Conclusions: Pathological myopia prevalence in Egypt seems to compare to or exceed that present in other countries, although a study of the prevalence in the general population is needed to confirm this finding. This prevalence seems to be increasing over time. The prevalence of manifestations of pathological myopia found in Egyptian eyes was comparable to rates found in other countries, although ethnic and genetic differences seem to play a role.