The oculocardiac reflex as a surgical aid in identifying a slipped or 'lost' extraocular muscle

The oculocardiac reflex during strabismus surgery has generally been regarded as a hazard capable of causing death. Six cases are presented which show a beneficial use of the oculocardiac reflex. Isolation of a previously slipped or 'lost' extraocular muscle can be difficult. In this series identification of the tissue as muscle was substantiated by observing a positive oculocardiac reflex when traction was placed on the suspected tissue. Each of the 6 dislodged extraocular muscles was the medial rectus muscle. Three of the muscles had been resected and 3 either recessed or tenotomised. In one patient, despite 6 previous strabismus operations, including 2 strabotomies on a muscle that slipped, and in another patient, who had a lapse of 6 years since the last strabotomy, when the slipped muscle was isolated, the oculocardiac reflex could still be elicited. To avoid abolishing the oculocardiac reflex during surgery the anaesthetist should be instructed to avoid the use of an intravenous parasympatholytic agent, such as atropine, at the time of induction and during the operation.