Autonomic dysreflexia is a syndrome which occurs in patients with lesions of the spinal cord above T6, and it is characterized by exaggerated autonomic responses to stimuli which are innocuous in normal individuals. Clinical features of 68 patients with autonomic dysreflexia in traumatic myelopathy are presented and special attention is drawn to ocular manifestations of autonomic dysreflexia. The symptoms, signs, laboratory findings, differential diagnosis, pathophysiology and management have been critical analysed and pertinent literature has been extensively reviewed. A plea is made for those involved in the management of spinal cord injury patients (irrespective of specialty) to be aware that autonomic dysreflexia can be a life-threatening problem if not promptly recognized and appropriately treated.