Purpose To assess relationships between carotid artery atherosclerosis and retinal arteriolar and venular diameters. Methods The community-based longitudinal Asymptomatic Polyvascular Abnormalities Community Study (APAC) included a sub-population of the Kailuan study which consisted of 101,510 employees and retirees of a coal mining industry. Based on the Chinese National Census 2010 and excluding individuals with history of cerebrovascular ischemic events, 4004 individuals were included into the APAC. All participants underwent a detailed clinical examination including blood laboratory tests and carotid artery duplex ultrasound examination. The cerebrospinal fluid pressure (CSFP) was estimated using the formula: CSFP[mmHg] = 0.44xBody Mass Index[kg/m(2)]+ 0.16xDiastolic Blood Pressure[mmHg]-0.18 x Age[Years]-1.91. Results In multivariable analysis (goodness of fit r(2) : 0.12), thicker retinal arteries were associated with a thinner common carotid artery intima-media thickness (IMT) (P = 0.002; standardized regression coefficient beta:-0.06; non-standardized regression coefficient B:-6.92; 95% confidence interval (CI):-11.2,-2.61) after adjusting for thicker retinal nerve fiber layer (P< 0.001; beta: 0.18; B: 0.35; 95% CI: 0.28,0.42), lower diastolic blood pressure (P<0.001; beta:-0.16; B:-0.17; 95% CI:-0.21,-0.3), younger age (P<0.001; beta:-0.08; B:-0.16; 95%; CI:-0.25,-0.08), and less abdominal circumference (P = 0.003; beta:-0.06; B:-0.11; 95% CI:-0.18,-0.03). Thicker retinal vein diameter was associated (r = 0.40) with higher estimated CSFP (P<0.001; beta: 0.09; B: 0.78; 95% CI: 0.47,1.08) after adjusting for wider retinal arteries (P<0.001; beta: 0.27; B: 0.36; 95% CI: 0.31,0.41), thicker retinal nerve fiber layer thickness (P = 0.03; beta: 0.22; B: 0.56; 95% CI: 0.46,0.65) and male gender (P<0.001; beta:-0.08; B:-3.98; 95% CI:-5.88,2.09). Conclusions Thinner retinal artery diameter was significantly, however weakly, associated with increased common carotid artery IMT. It suggests that retinal microvascular changes were only week indicators for an atherosclerotic carotid artery pathology. Thicker retinal vein diameter was associated with higher estimated CSFP, confirming associations between higher estimated CSFP and higher incidence of retinal vein occlusion.