Background: Laparoscopic surgeries performed in steep Trendelenburg position with pneumoperitoneum cause significant intraocular pressure (IOP) elevation, posing a potential risk for perioperative ocular complications. Anaesthetic technique plays a crucial role in modulating these changes. This study compares the effects of Total Intravenous Anaesthesia (TIVA) using propofol versus desflurane-based inhalational anaesthesia on IOP and haemodynamic stability. Methodology: A prospective, randomized comparative study was conducted on 60 patients (ASA I–II) undergoing elective laparoscopic surgery. Patients were assigned to either the Propofol TIVA group (Group P, n=30) or the Desflurane group (Group D, n=30). Intraocular pressure was recorded at baseline, post-induction, after pneumoperitoneum, and at 10, 30, and 60 minutes of Trendelenburg, followed by the return to supine position. Haemodynamic parameters were also assessed. Statistical analysis was performed using t-tests and chi-square tests, with p<0.05 considered significant. Results: Baseline demographics were comparable across groups. Group D showed significantly higher IOP at all surgical stress points—after induction (p=0.01), after pneumoperitoneum (p<0.001), and during Trendelenburg at 10, 30, and 60 minutes (all p<0.001). IOP returned toward baseline after resuming supine position but remained significantly higher in Group D (p<0.001). Haemodynamic variables including mean arterial pressure showed no significant intergroup differences at any time point. Conclusion: Propofol-based TIVA is more effective in attenuating intraoperative IOP rise than desflurane anaesthesia during laparoscopic surgeries requiring pneumoperitoneum and Trendelenburg position. Both techniques provide stable haemodynamics; however, TIVA may be preferable in patients at risk for ocular hypertension or glaucoma.