Background: Diabetes Mellitus (DM) is a significant global health issue, contributing to various ocular complications. Early detection is crucial to preventing visual impairment, especially in underserved rural populations. This study assesses the prevalence of ocular manifestations in diabetic patients from a rural tertiary care centre. Methods: A prospective study was conducted at Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh, India, from April 2021 to March 2024. A total of 5,162 diabetic patients (Type 1 and Type 2) underwent comprehensive ophthalmic evaluations, including visual acuity, intraocular pressure, and fundus examinations. Systemic and laboratory investigations supplemented the findings. Data were analyzed to determine the prevalence of ocular conditions. Results: Ocular manifestations were present in 89% of patients, with cataracts (30%), dry eye syndrome (26%), diabetic retinopathy (20%), and glaucoma (12%) being the most common. Other conditions included blepharitis (8%), recurrent chalazion (6%), and anterior ischemic optic neuropathy (2%). Patients aged 25-50 constituted 52%, while 44% were above 50. Conclusion: The study highlights a high prevalence of ocular complications in rural diabetic patients, particularly cataracts, dry eye syndrome, and diabetic retinopathy. These findings emphasise the need for early screening and patient education to prevent visual impairment and ensure timely management.