In Reply We thank Dr Miller for his comments regarding the recently published article1 on the incidence and etiologies of acquired third nerve palsy, and on our accompanying commentary.2 We stated that all patients with an isolated third nerve palsy should receive noninvasive brain imaging to not miss potential life-threatening conditions such as intracranial aneurysms. This statement applies only to the subgroup of patients with an isolated third nerve palsy and cannot be extrapolated to patients with a nonisolated third nerve palsy or those with fourth or sixth cranial nerve palsies, which are infrequent harbingers of life-threatening neurologic problems.
Newman NJ, Biousse V. When Should Emergent Imaging Be Performed?—Reply. JAMA Ophthalmol. Published online May 25, 2017. doi:10.1001/jamaophthalmol.2017.1433