Dilantin-induced long-term bilateral total external ophthalmoplegia.

A young, healthy woman underwent craniotomy for the resection of a corpus callosum arteriovenous malformation. She was slow to awaken from anesthesia and was later noted to have a total external ophthalmoplegia. Her mental status quickly improved but the total ophthalmoplegia showed only minimal improvement for 2 weeks. After ruling out possible cerebrovascular and anesthetic complications, we concluded that the oculomotor impairment was due to postoperative toxic levels of Dilantin. Toxic Dilantin levels are known to rarely produce total ophthalmoplegia. In previously reported cases, this has always resolved with normalization of the serum Dilantin levels. This case represents the first report of Dilantin-induced ophthalmoplegia that took at least 3 months to resolve; it provides a detailed documentation of the course of ocular findings.