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Footnotes to the Rule

Jonathan D. Trobe, MD

Arch Ophthalmol. 1988;106(5):601-602.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In this issue, Lustbader and Miller¹ describe a 65-year-old hypertensive woman with an isolated, pupil-sparing third nerve palsy and complete paralysis of extraocular muscles that were caused by a basilar artery aneurysm. The case reached these pages because it violates The Rule of the Pupil in Third Nerve Palsy and forces a reexamination of how the rule applies to the treatment of such patients.

See also p 583.

The rule states that when aneurysms compress the oculomotor nerve, the iris sphincter will be impaired, leading to a dilated or sluggishly reactive pupil. A persuasive guideline, the rule was born in 1958 when Rucker² reported that 62 (97%) of 64 aneurysmal third nerve palsies did not spare the pupil. In the two cases in which the sphincter was unimpaired, Rucker said that "involvement of the extraocular muscles was slight"—an important point that has often been ignored.

The rule has . . . [Full Text PDF of this Article]

Author Affiliations
Ann Arbor, Mich

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