The authors present the findings of a retrospective records review of 300 new patients at a single tertiary neuro-ophthalmology clinic by two ophthalmologists. The case selection was taken from 45 randomly selected days over a four-year period. The authors reported the most common sources of referrals to neuro-ophthalmology were ophthalmology, neurology and optometry. A high proportion of patients had seen multiple healthcare professionals prior to assessment by a neuro-ophthalmologist. Most of the referrals were judged to be appropriate. Referral diagnosis accuracy was deemed low by the authors. Female patients were found to be significantly more likely to be misdiagnosed. Some conditions were over-diagnosed by referrers, for example optic neuropathies, idiopathic intracranial hypertension (IIH) and ocular myasthenia gravis, whereas other conditions were missed, including nonarthritic anterior ischemic optic neuropathy (NAION), glaucoma, optic nerve sheath meningioma and hereditary optic neuropathies. Of the patients reviewed there was evidence of delay in care, misdiagnosis and unnecessary tests performed. A very small number of the sample were not impacted by receiving a neuro-ophthalmology assessment, with one fifth experiencing a significant impact. This study highlighted the role that neuro-ophthalmologists play in the diagnosis and management in a wide range of neuro-ophthalmic conditions. The limit of this study is it being a retrospective review at one tertiary centre.