Oculocardiac Reflex in an Orbital Fracture Without Entrapment.

Abstract

Large orbital fractures in older patients are infrequently associated with an exaggerated oculocardiac reflex. This report describes the case of a patient in his 40s with a large right orbital floor and medial wall fracture without radiographic evidence of extraocular muscle compression or entrapment who developed severe nausea and bradycardia with movement of his affected eye. The patient exhibited bradycardia to 17 beats per minute during the initial examination and was taken urgently to the operating room for reconstruction of the right orbital floor and medial wall. Additional episodes of bradycardia intraoperatively were responsive to glycopyrrolate. After the procedure, the patient's pain was decreased, a normal range of motion was restored, and the bradycardia and nausea resolved. An explanation for induction of the oculocardiac reflex is considered in the absence of clinical or radiologic entrapment because large orbital fractures are not often considered to induce this reflex.

• Authors: Timothy C Woernley, Thomas L Wright, Duc N Lam, Jonathon S Jundt
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 75 Issue 8 Pg. 1716-1721 (Aug 2017) ISSN: 1531-5053 [Electronic] United States
• PMID: 28412263 (Publication Type: Case Reports, Journal Article)
• Copyright: Published by Elsevier Inc.

Topics

• Adult
• Eye Movements (physiology)
• Heart Rate (physiology)
• Humans
• Imaging, Three-Dimensional
• Male
• Orbit (diagnostic imaging, surgery)
• Orbital Fractures (diagnostic imaging, physiopathology, surgery)
• Reflex, Oculocardiac (physiology)
• Tomography, X-Ray Computed