Objective: To investigate the current status of medication use in neuro-ophthalmology, evaluate off-label drug use, and explore scientific and effective management strategies, providing references for rational drug use in neuro-ophthalmology clinical practice. Methods: We Randomly selected neuro-ophthalmology prescriptions from July to December 2023 in our hospital. By refering to the drug instructions approved by the National Medical Products Administration, FDA instructions, and evidence from evidence-based medical databases such as PubMed and Micromedex, we identified and classified the types of off-label drug use, including off-label indications, off-label doses, off-label courses, off-label administration routes, among others. Simultaneously, based on the Thomson classification theory, we established a threelevel evaluation standard: Level A (high evidence level, requiring only oral notification); Level B (medium evidence level, necessitating detailed records in the medical record or medical course); Level C (low evidence level, demanding patients sign a written informed consent form). Through the intervention of pre-prescription review system, we carried out real-time interception and classification warnings for off-label drug use not covered in the evaluation standards. We then compared the changes in the unreasonable rate of off-label drug use prescriptions from the second half of 2023 (before intervention) to the second half of 2024 (after intervention). Results: Before the intervention, a total of 1852 prescriptions were selected, with the proportion of off-label drug use at 19.98% (370 prescriptions), primarily involving off-label indications (90.27%). After the intervention, the unreasonable rate of off-label drug use decreased from 9.2% (34/370) to 2.9% (16/560). Conclusions: Off-label drug use is prevalent in neuro-ophthalmology, mainly due to the conflict between the treatment requirements for complex diseases such as optic neuritis and ischemic optic neuropathy and the delay in drug approval. By constructing a hierarchical management system based on evidence-based medical evidence and combing it with real-time information-based intervention, we can effectively regulate off-label drug use behavior and reduce medical risks.