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NEUROLOGY 1981;31:1188
© 1981 American Academy of Neurology

Amitriptyline-induced ophthalmoplegia

Robert H. Spector, M.D. and Robert Schnapper, M.D.

Department of Neurology, Emory University School of Medicine, Atlanta, GA.

Total external ophthalmoplegia, unresponsive to caloric stimulation, was observed in a gravid woman who had ingested approximately 1.0 to 1.5 gm of amitriptyline. The intravenous administration of 4.0 mg physostigmine salicylate (PS) produced a revival of consciousness and reflex activity but had no appreciable effect on ocular motility. A prior case report of amitriptyline-induced ophthalmoplegia in a patient who took lesser amounts of the medication described immediate restoration of eye movement with only 2 mg of intravenous PS. The action of the amitriptyline on the vestibuloocular reflex seems to involve cholinergic transmission and the effect of the drug may be dose related.

Address correspondence and reprint requests to Dr. Spector, Emory University Clinic, 1365 Clifton Road, N.E., Atlanta, GA 30322.

Accepted for publication December 1, 1980.






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