Orbital Trauma, Bradycardia, and Vomiting: Trapdoor Fracture and the Oculocardiac Reflex

Jackson, Benjamin F.

doi:10.1097/pec.0b013e3181ce30d8

Cited by 16 publications

(4 citation statements)

References 19 publications

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“…Pozitivna klinička slika uključuje laceraciju ili abraziju, periorbitalno oticanje, ograničenje pokreta očnih jabučica pri pogledu nagore, praćeno binokularnom diplopijom, okulokardijalni refleks i pozitivan test prinudne dukcije. Iako okulokardijalni refleks ostaje klasičan nalaz, on je takođe bio indikacija za operaciju, jer duže trajanje refleksa može dovesti do bradikardije i srčanog bloka 8,9 . Radiografski, belooki blowout prelom dokazan je postojanjem uklještenja mekog tkiva (donji pravi mišić oka) i preloma donjeg orbitalnog oboda.…”

Section: Discussionunclassified

“…The positive clinical presentation includes laceration or abrasion, periorbital swelling, restriction of eye movements in superior gaze with binocular diplopia, oculocardiac reflex and positive forced duction test. Though oculocardiac reflex remains a classical finding, it is also an indicator for surgery as the long term persistence of reflex may lead to bradycardia and heart block 8,9 . Radiographically, white eye blow fracture evidenced with soft tissue (inferior rectus muscle) entrapment and fracture of the inferior orbital rim.…”

Section: Discussionmentioning

confidence: 99%

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White-eyed blowout fracture: A 10 days delayed surgical intervention and outcomes: A case report

Kattur¹,

Balamurugan²

2021

Acta stomatologica Naissi

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The basis of the problem: Craniomaxillofacial trauma in pediatric group is less common with an incidence rate of 15% and the most commonly involved site is the fracture of orbital floor. Blow out fractures can either be pure or impure with trauma being the most predominant etiology. Method: Our case report present a 15 year old patient with a diagnosis of white eye blow out fracture reported ten days post trauma. The case was surgically dealt by releasing the entrapped inferior rectus muscle and placement of titanium mesh in the orbital floor with a postoperative follow up period of 6 months. Results: In the present report, although the eye movements i were evident without any restriction, the authors were unable to achieve a full range of eye movements due to delayed surgical intervention. Conclusion: Inferior rectus muscle entrapment is the most common entity encountered in cases of white eye blow out fractures, due to its close proximity with the orbital floor and lack of periodontal fat. Early diagnosis and immediate surgical intervention would bring about a best positive outcome in the management of white eye blow out fractures.

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Section: Discussionunclassified

Section: Discussionmentioning

confidence: 99%

White-eyed blowout fracture: A 10 days delayed surgical intervention and outcomes: A case report

Kattur¹,

Balamurugan²

2021

Acta stomatologica Naissi

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“…It is uncommonly seen after infiltration of local anaesthesia for cataract surgery, during ocular surgeries such as correction of strabismus, enucleation, periorbital tumour excision and blepharoplasty 3 6 8 12. There have been only a few cases reported in the paediatric and emergency medicine literature 1 4…”

Section: Discussionmentioning

confidence: 99%

A case of ocular cardiac reflex in a child with blunt ocular trauma

et al. 2014

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An 11-year-old boy re-presented with refractory vomiting 18 h after blunt facial and head trauma. Initial CT of the brain performed at his first visit was normal. He was found to have a heart rate of 56 bpm (age appropriate 65-100 bpm) with a blood pressure 90/60 mm Hg. Physical examination revealed an injected sclera and limited vertical movement of the left eye. Neurological examination revealed no focal deficits, but a Glasgow Coma Scale of 14, with mild confusion, depressed mental status and diplopia on upward gaze. Performing upward gaze extra ocular movements exacerbated the patient's bradycardia and confirmed the presence of the oculocardiac reflex. High-resolution CT of orbits demonstrated a left orbital floor fracture with entrapment of the left inferior rectus muscle. Surgical correction resolved his bradycardia.

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“…Trapdoor fractures most often involve the orbital floor3 and not surprisingly an oculocardiac reflex has most often been described in association with inferior trapdoor fractures 145. Medial trapdoor fractures with and without oculocardiac reflex have also been described 67.…”

Section: Case Reportmentioning

confidence: 99%

Oculocardiac reflex in a medial orbital wall fracture without clinically evident entrapment

Swamy

Phan

Sadah

et al. 2013

Middle East Afr J Ophthalmol

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In this report, we describe a patient with a medial wall orbital fracture, who presented with vasovagal-like symptoms secondary to an oculocardiac reflex. This case is unusual because the patient had no other clinical evidence of muscle entrapment. A 15-year-old male presented with daily 5-10 min episodes of dizziness, light headedness, and nausea consistent with a vasovagal reaction. On examination, the patient had full extra ocular motility and was orthotropic in all fields of gaze. On computed tomography a comminuted medial orbital wall fracture was identified. The adjacent medial rectus muscle was in normal position, but was “rounded” relative to the contralateral side. The patient underwent fracture repair with immediate resolution of all symptoms. Symptoms related to a vasovagal response may occur with orbital fractures despite normal extra ocular motility. Presumably this relates to tension or pulling on an extra ocular muscle, which is not to a degree that alteration in function is appreciable clinically.

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Orbital Trauma, Bradycardia, and Vomiting: Trapdoor Fracture and the Oculocardiac Reflex

Cited by 16 publications

References 19 publications

White-eyed blowout fracture: A 10 days delayed surgical intervention and outcomes: A case report

White-eyed blowout fracture: A 10 days delayed surgical intervention and outcomes: A case report

A case of ocular cardiac reflex in a child with blunt ocular trauma

Oculocardiac reflex in a medial orbital wall fracture without clinically evident entrapment

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