Although the incidence of neuro-ophthalmic emergencies is much lower than other ophthalmic emergencies, such as retinal detachment or ruptured globe, their outcomes carry a much higher morbidity and even mortality. Neuro- ophthalmic emergencies are a group of diverse disorders that may present with visual loss as in giant cell arteritis and toxic optic neuropathy, ophthalmoplegia as in cavernous sinus thrombosis and intracranial aneurysm or both visual loss and ophthalmoplegia as in orbital apex syndrome and pituitary apoplexy. Head trauma can cause visual abnormalities that involve any part of the afferent or efferent visual pathway and neuro-ophthalmic evaluation of head trauma patient can be life saving as in temporal herniation. Transient monocular visual loss may herald permanent visual loss or a devastating stroke and should be urgently evaluatedandmanaged.Historytaking,meticulousexaminationand investigations including neuro-imaging are the corner stone for accurate diagnosis and proper management. This essay reviews causes, mechanisms, manifestations and complications of neuro-ophthalmic emergenciesand their management focusing on the value of early diagnosis and proper management.