Oculocardiac reflex elicited during debridement of an empty orbit

Tsai, James C.; Heitz, James W.

doi:10.1016/j.jclinane.2011.07.007

Cited by 7 publications

(1 citation statement)

References 8 publications

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“…1 , 2 Well-known in the pediatric ophthalmology and anesthesiology literature, this reflex has also been reported in a variety of adult surgeries including maxillofacial surgeries involving the maxillary and mandibular distributions of the trigeminal nerve, skull base surgeries, and even surgery involving an empty orbit. 3 , 4 , 5 The OCR has also been described in the setting of trauma, most commonly associated with trapdoor fractures involving entrapment of an extraocular muscle. 6 , 7 Here we describe a case of the OCR resulting in autonomic instability elicited by total globe dislocation through a large orbital floor fracture.…”

Section: Introductionmentioning

confidence: 99%

Oculocardiac reflex elicited by orbital floor fracture and inferior globe displacement

Pham

Couch

2017

American Journal of Ophthalmology Case Reports

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PurposeTo review the physiology, presentation and management of the oculocardiac reflex (OCR) by describing a case of the OCR associated with an orbital foreign body and complete ocular prolapse through a large orbital floor fracture in a 40-year-old male following a motor vehicle accident.ObservationsThe patient demonstrated marked bradycardia and hypotension necessitating intubation and medical therapy for autonomic shock. A computed tomography (CT) showed a total blow out floor fracture and complete dislocation of a radiographically intact globe with uninterrupted rectus muscle attachments into the left maxillary sinus. He was taken to the operating room for urgent repair resulting in subsequent termination of severe OCR.Conclusions and importanceThe oculocardiac reflex can precipitate marked bradycardia and hypotension in the setting of trauma with significant orbital and maxillofacial injury. Prompt identification and management with vagolytic agents or definitive surgical intervention may prevent morbidity or mortality.

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