According to a 2008 report by America’s Health Insurance Plans, up to half of all diagnostic testing including computed tomographic (CT) imaging and magnetic resonance imaging (MRI) is thought to be medically unnecessary. In ophthalmology, many isolated ocular emergencies can be diagnosed by fundus examination and do not require advanced neuroimaging. The purpose of this study was to evaluate the use of advanced neuroimaging in the emergency department (ED) for ocular complaints. This is a retrospective chart review of all patients with ophthalmic emergencies presenting to the Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Sibley Memorial Hospital ED’s between June 2016 and May 2017 who received advanced neuroimaging and ophthalmology consultation. Necessity of advanced neuroimaging was determined based on whether or not presentations could be diagnosed by ophthalmic exam. Five hundred thirty-six patients were identified. The mean age of patients (±SD) was 44.9 (±21.0) years and 50.9% (n=273) were male. Forty-eight percent of patients (n=259) were White, 39.4% (n=211) Black, 8.4% (n=45) Hispanic, 3.0% (n=16) Asian, and 9.3% (n=50) other. All patients with final diagnoses of orbital fracture (n=26, 4.9%), optic neuritis (n=26, 4.9%), cranial nerve palsy (n=15, 2.8%), stroke (n=13, 2.4%), ruptured globe (n=12, 2.2%), malignancy (n=11, 2.1%), idiopathic intracranial hypertension (n=11, 2.1%), diplopia (n=10, 1.9%), visual loss (n=9, 1.7%), amaurosis fugax (n=5, 0.9%), optic nerve disorder (n=4, 0.7%), retrobulbar hemorrhage (n=4, 0.7%), abscess (n=3, 0.6%), eye problem (n=3, 0.6%), eye swelling (n=2, 0.4%), giant cell arteritis (n=2, 0.4%), retinal artery branch occlusion (n=2, 0.4%), and strabismus (n=2, 0.4%) received necessary advanced neuroimaging. All patients with final diagnoses of conjunctivitis (n=11, 2.1%), retinal detachment (n=7, 1.3%), cataract (n=4, 0.7%), acute angle closure glaucoma (n=3, 0.6%), hordeolum (n=3, 0.6%), dacrocystitis (n=2, 0.4%), floaters (n=2, 0.4%), uveitis (n=2, 0.4%), vitreous detachment (n=2, 0.4%), and zoster ophthalmicus (n=2, 0.4%) received unnecessary advanced neuroimaging. Eighty-one percent (n=435) of patients underwent CT only, 14.9% (n=65) underwent MRI only, and 6.7% (n=36) underwent both. Sixty-two percent (n=330) of patients were discharged from the ED, 37.5% (n=201) were admitted, 0.7% (n=4) left against medical advice, and 0.2% (n=1) placed in observation. Of various ocular emergencies in which advanced neuroimaging was not required, conjunctivitis and retinal detachment were the most common causes of unnecessary imaging. Imaging was necessary for most patients with final diagnoses of trauma and neurologic disorders. CT was the most common type of imaging modality performed.