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Oculocardiac Reflex in an Orbital Fracture Without Entrapment
Timothy C Woernley1, Thomas L Wright2, Duc N Lam1
1Resident, Department of Oral Maxillofacial Surgery, Texas Medical Center, University of Texas at Houston, Houston, TX.
Summary
Large orbital fractures can cause exaggerated oculocardiac reflex, leading to bradycardia and nausea. This case highlights the reflex in a patient without muscle entrapment, emphasizing prompt surgical intervention.
Area of Science:
- Ophthalmology
- Trauma Surgery
- Cardiology
Background:
- Large orbital fractures are typically not associated with exaggerated oculocardiac reflex (OCR).
- OCR is a reflex bradycardia caused by stimulation of the trigeminal nerve during ocular manipulation.
Observation:
- A patient in his 40s presented with a large right orbital floor and medial wall fracture.
- He experienced severe nausea and bradycardia (down to 17 bpm) with eye movement, despite no radiographic evidence of muscle compression or entrapment.
Findings:
- Surgical reconstruction of the orbital fracture resolved the bradycardia and nausea.
- Intraoperative bradycardia episodes responded to glycopyrrolate, suggesting a vagal response.
Implications:
- This case suggests that large orbital fractures, even without entrapment, can induce a significant oculocardiac reflex.
- It underscores the importance of recognizing and managing OCR in orbital trauma patients, regardless of entrapment status.