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    Cranial motor nerve palsy is the initial ophthalmic presentation of giant cell arteritis in about 10% of patients; it is due to nerve ischemia resulting from occlusion of the vascular supply to the nerve. Most commonly, the third cranial nerve is affected, producing ptosis and outward deviation of the eye on the involved side (as seen here), with sparing of the pupil. In the elderly, a cranial nerve palsy should raise suspicion of giant cell arteritis, especially if accompanied by headache or pain.