The authors sought to answer the question of to what extent do differences in policy exist between ophthalmologists and neurologists regarding imaging by MRI of patients with acquired ocular cranial nerve palsy (CNP). They conducted a literature review leading to selection of 10 suitable papers out of 2505; reporting 889 cases of cranial nerve palsy; 770 assessed by ophthalmologists and 119 by neurologists. Patients were aged two to 96 years. There were 162 third nerve palsies, 131 fourth and 486 sixth nerve palsies. All neurologists (n=3) and two of seven ophthalmologists recommended performing MRI for all patients with third nerve palsy. Five of seven ophthalmologists recommended a triage process for risk factors associated with cranial nerve palsy prior to ordering MRI. At sub-analysis all agreed imaging for third nerve palsy and for patients <50 years of age.