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Nonmydriatic ocular fundus photography in neurologic emergencies. IMPORTANCE: The ocular fundus examination is infrequently and poorly performed in clinical settings, placing patients at risk for missed and delayed diagnosis of vision- and life-threatening neurologic disease. OBJECTIVES: To review the importance of ocular fundus examination, the limitations of direct ophthalmoscopy, and the relative merits of nonmydriatic ocular fundus photography in emergency neurologic diagnosis. EVIDENCE REVIEW: PubMed queries were reviewed for articles of relevance to this review. Queries included relevant combinations of the search terms ophthalmoscopy, nonmydriatic, neurology, and emergency, including variant spellings and endings. FINDINGS: Nonmydriatic ocular fundus photography is more sensitive than direct ophthalmoscopy in several settings. It can be feasibly performed in emergency departments and has substantial promise in improving neurologic diagnosis, particularly headache and cerebrovascular disease. CONCLUSIONS AND RELEVANCE: Nonmydriatic ocular fundus photography has notable advantages over direct ophthalmoscopy that likely outweigh its associated costs. More widespread deployment and integration into neurologic practice is expected to improve diagnosis and patient outcomes.