The patient Wang, 60 years old, suddenly could not open his left eye, consulted ophthalmology, ophthalmology diagnosed as arteriovenous nerve palsy, requested neurosurgery consultation, performed cranial CTA examination: left posterior communicating artery aneurysm, three days after performing open cerebral aneurysm clamping, the left eyelid could be opened. In clinical work, we found that most of the aneurysms causing arteriovenous nerve palsy are: posterior communicating artery aneurysm, aneurysm at the bifurcation of the internal carotid artery, aneurysm of the P1 segment of the posterior cerebral artery. Ophthalmic aneurysms and basilar aneurysms are also occasionally seen. Aneurysms in these areas compress the arteriolar nerve, resulting in arteriolar nerve palsy, which is manifested by inability to open the eyelids, abduction of the eyeballs, and dilated pupils. Surgical clamping of the aneurysm and puncturing the aneurysm to collapse it and stop filling it with blood relieves the articulating nerve from the compression of the aneurysm, and the patient’s eye symptoms recover in a short time. Therefore, in daily life, if the eyelid cannot be opened, one must think of the possibility of intracranial aneurysm.