In malaria endemic areas, a high proportion of children have detectable parasitemia but show no clinical symptoms. When comatose from a cause other than malaria, this group confounds the cerebral malaria (CM) definition, making accurate diagnosis challenging. One important biomarker of CM is malarial retinopathy, a set of specific features visible in the ocular fundus. In this study, we quantified the contribution of malarial retinopathy in discriminating malaria-caused coma from non-malaria-caused coma. We estimated that 10% of our study cohort of n = 1,192 patients who met the WHO clinical definition of CM in Malawi had non-malarial coma based on a Gaussian mixture model using the parasite protein Plasmodium falciparum histidine-rich protein-2 (PfHRP2). A classification based on platelets, white blood cells and retinopathy significantly improved the discriminative power of a previously established model including only platelets plus white blood cells (AUROC: 0.89 vs. 0.75, p-value < 0.001). We conclude that malarial retinopathy is highly predictive of malaria-caused vs. non-malaria-caused coma and recommend an ocular funduscopic examination to determine malarial retinopathy status be included in the assessment of parasitemic comatose African children.