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Updated: May 16, 2026

Surgical Correction for Pediatric Epiblepharon and Trichiasis
03:59

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Published on: July 8, 2025

Oculocardiac Reflex During Strabismus Surgery: Conjunctival Incision versus Standardized Rectus Muscle Traction.

Breckin J Reicks1, Travis Bond2, Leif Lunoe2

  • 1Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK, USA.

Clinical Ophthalmology (Auckland, N.Z.)
|May 15, 2026
PubMed
Summary
This summary is machine-generated.

Strabismus surgery involving extraocular muscle (EOM) tension significantly impacts heart rate via the oculocardiac reflex (OCR). Conjunctival incision, however, shows minimal effect on heart rate during these procedures.

Keywords:
bradycardiaoculocardiac reflexpainstrabismus surgerytrigeminovagal reflex

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Area of Science:

  • Ophthalmology
  • Cardiology
  • Surgical Anesthesia

Background:

  • Extraocular muscle (EOM) tension during strabismus surgery can induce trigemino-vagal bradycardia, a manifestation of the oculocardiac reflex (OCR).
  • Surface pain in the eye is known to cause bradycardia in premature infants during eye examinations.

Purpose of the Study:

  • To evaluate the impact of different surgical aspects of strabismus surgery on heart rate.
  • To compare the oculocardiac reflex (OCR) response to conjunctival incision versus extraocular muscle (EOM) tension.

Main Methods:

  • Monitored electrocardiograph heart rate (H.R.) during outpatient strabismus surgery without anticholinergic or local anesthetic.
  • Compared the effects of limbus-based conjunctival incision against 200-gram, 10-second tension applied to rectus muscles.

Main Results:

  • Conjunctival incision resulted in a minimal change in heart rate (median 100 bpm to 103 bpm).
  • Rectus muscle tension caused a significant drop in heart rate (median 102 bpm to 75 bpm), with younger patients exhibiting a greater percentage drop.
  • The observed differences in heart rate changes were statistically significant (Kruskal-Wallis X2(2) = 251, p < 0.001) and independent of various patient factors and medications.

Conclusions:

  • Conjunctival incision elicits minimal oculocardiac reflex (OCR) compared to extraocular muscle (EOM) tension, even under general anesthesia.
  • This suggests that EOM manipulation is the primary driver of OCR during strabismus surgery.