Orbital trauma and its impact on the heart

We present the case of a 16-year-old boy, who was hit in the right orbital region during a soccer match. Immediately after the blow, the patient felt nauseous and fell to the ground. The otherwise healthy patient presented with headache, nausea and sinus bradycardia (38 bpm). Clinically there were no obvious signs of fracture of facial bones. There was no sign of injury to the eyes, only the right globe was slightly restricted in movement. With suspicion of head injury, a CT scan was performed revealing a trapdoor fracture of the medial orbital wall. The medial rectus muscle was entrapped within the fracture inducing the oculocardiac reflex. The trapped rectus muscle was released endoscopically on the same day and the heart rate normalised. Early surgical intervention is recommended to avoid prolonged muscle ischaemia and to shorten the vagal symptoms.