Amitriptyline-induced ophthalmoplegia

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.