Oculocardiac Reflex in an Orbital Fracture Without Entrapment

Woernley, Timothy C.; Wright, Thomas L.; Lam, Duc N.; Jundt, Jonathon S.

doi:10.1016/j.joms.2017.03.014

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…Clinically, the OR has been observed in procedures involving direct or indirect manipulation of the orbit or orbital contents, especially of the medial rectus and inferior oblique muscles 6,8,11 . In maxillofacial trauma, precipitation of an OR can include spontaneous eye movement during ophthalmologic assessment, intraoperative direct manipulation of orbital contents, or indirect stimulus to periorbital tissue after reduction of zygomaticomaxillary complex fractures.…”

Section: Discussionmentioning

confidence: 99%

“…The oral and maxillofacial surgeon should remember that the OR could occur at any time there is manipulation around the globe. By identifying at-risk patients or procedures and by monitoring the electrocardiogram for arrhythmias and bradycardia, early detection is possible and, fortunately, the heart rebounds dramatically on termination of the stimulus 6 . In orbital surgery, the nature of the stimulus is the most important risk factor in inducing this reflex; therefore, abrupt and sustained manipulation of the trigeminal nerve should be avoided.…”

Section: Discussionmentioning

confidence: 99%

“…They described it occurring in a group of young patients (less than 16 years of age) with little or no clinical evidence of soft tissue trauma, diplopia with restriction of the vertical gaze, lack of exophthalmos, and radiographic signs of minimal bone displacement with or without tissue herniation into the maxillary sinus. In an even more serious scenario, these patients may have true entrapment of the inferior rectus, pain with restricted ocular movement, and autonomic signs, which are secondary to the oculocardiac reflex (OR) 6 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

Brasileiro

Sickels

Cunningham³

2020

JKAOMS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

Brasileiro

Sickels

Cunningham³

2020

JKAOMS

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“…The incidence of retrobulbar hematoma after facial trauma is less than 1%, but can cause blindness in up to 48% of cases [18]. Furthermore, the oculocardiac reflex has been shown to occur in fractures without entrapment [19]. Therefore, it is important to evaluate for bradycardia in all orbital fractures, regardless of the presence of entrapment.…”

Section: Reviewmentioning

confidence: 99%

The ‘White-eyed’ Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

Saggese

Mohammadi

Cardo

2019

Cureus

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The ‘white-eyed’ blowout fracture (WEBOF) is an injury that is often overlooked in head trauma patients, as it often has few overt clinical and radiographic features. Although benign in appearance, it can lead to significant patient morbidity. Here, we intend to increase the awareness of WEBOF and provide general principles for its diagnosis. WEBOF should be recognized early to ensure timely management and a successful outcome.

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“…However, it can occur during other ophthalmic surgeries such as blepharoplasty, 3,4 phacoemulsification, 5 or procedures involving the orbitozygomatic approach. 6 OCR has also been described in orbital trauma with or without muscle entrapment, 7–9 retrobulbar hematoma, 10 orbital tumor, 11 local anesthetic injection in an empty orbit, 12 and even contact lens adaptation. 13 The main effect of this reflex is sinus bradycardia regressive by tension-releasing (by lateral canthotomy and cantholysis in the case of retrobulbar hematoma) and, if necessary, atropine intravenous injection.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery

Ducloyer¹,

Couret²,

Magne

et al. 2018

European Journal of Ophthalmology

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Purpose: To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac reflex, postoperative nausea and vomiting, and postoperative pain. Methods: This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron. No drug-based prevention of oculocardiac reflex or local/locoregional anesthesia was employed. Results: A total of 106 pediatric ophthalmic surgeries completed between November 2015 and May 2016 were analyzed. The mean patient age was 4.4 (range: 0.2–7.3, standard deviation: 2.4) years. Ambulatory rate was 90%. Oculocardiac reflex incidence was 65% during strabismus surgery (34/52), 50% during congenital cataract surgery (4/8), 33% during intramuscular injection of botulinum toxin (1/3), and 0% during other procedures. No asystole occurred. Postoperative nausea and vomiting incidence was 9.6% after strabismus surgery (5/52) and 0% following the other procedures. One child was hospitalized for one night because of persistent postoperative nausea and vomiting. Postoperative pain generally occurred early on in the recovery room and was quickly controlled. Its incidence was higher in patients who underwent strabismus surgery (27%) than in those who underwent other procedures (9%). Conclusion: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit–risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented.

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Oculocardiac Reflex in an Orbital Fracture Without Entrapment

Cited by 11 publications

References 15 publications

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis

The ‘White-eyed’ Orbital Blowout Fracture: An Easily Overlooked Injury in Maxillofacial Trauma

Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery

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