Orbital mass in a child causing somnolence, nausea and bradycardia

To highlight the need for referral and prompt intervention when signs of increased intraorbital pressure are present.

A four year old child presented to hospital with orbital swelling of recent onset, nausea and somnolence. Computed tomography and brain scan demonstrated a normal brain with a mass in the left orbit. She was referred for ophthalmic surgery the following day, when she had lost responsiveness of her left pupil to light. Anaesthetic management was highlighted by the presence of preoperative signs and symptoms of increased intraocular pressure--somnolence, nausea and vomiting, and bradycardia. These signs and symptoms were alleviated postoperatively.

Rapid onset of orbital swelling with physiological signs of increased orbital pressure necessitate urgent surgical intervention. It is possible that early referral and surgery could have preserved some functional vision in a situation where the light reflex remained in the affected eye. Alleviation of preoperative nausea and vomiting, bradycardia, and somnolence indicates that the preoperative symptomatology was related to vagal stimulation from increased intraocular pressure, usually identified as an oculocardiac reflex.