This grand-rounds style course will highlight several unique neuro-optometry cases that the author has managed having high risk for ocular and/or systemic morbidity and/or mortality. This course will review and discuss underlying pathology, and decision-making pearls behind these generally rare neuro-optometry cases that can be vision and/or life-saving if caught by the eyecare practitioner and managed correctly in a timely manner. Interprofessional referrals will also be discussed to highlight co-management success.