In Reply We would like to thank Dr Miller for his interest in our article and his insightful comments. To clarify the results of our study, the 2 patients with aneurysms and complete external third nerve dysfunction both had pupil involvement.1 In addition, these were both caused by a posterior communicating artery aneurysm. Therefore, there were no cases of complete external third nerve dysfunction with pupil sparing that were caused by an aneurysm. To our knowledge, the only case of an aneurysm causing a complete external third nerve dysfunction without the involvement of the pupil was regarding the patient reported by Lustbader and Miller.2
Chen JJ, Fang C, Leavitt JA. When Should Emergent Imaging Be Performed?—Reply. JAMA Ophthalmol. 2017;135(7):820–821. doi:10.1001/jamaophthalmol.2017.1430
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