Oculocardiac Reflex Elicited From an Empty Orbit
Author: Edward Bedrossian Jr. MD FACS
Base Hospital / Institution: Wills Eye Hospital
ePoster presentation
Abstract ID: 25-135
Purpose
The oculocardiac reflex is a well described depressor reflex that may result in sinus bradycardia, heart block or asystole. Classically, it is precipitated by traction on the extraocular muscles or pressure on the globe and is commonly reported during strabismus surgery. We believe this is the first case of oculocardiac reflex during surgical manipulation of a previously exenterated orbit. This has potentially fatal implications for the unaware surgeon, anesthesiologist and patient.
Methods
Retrospective case report
Results
This is an 87 year old male with multiple lid procedures ,who underwent right orbital exenteration for invasive basal cell carcinoma into the right lacrimal sac and ethmoid bone. Frozen sections were free of tumor, but permanent sections revealed residual tumor in the posterior aspect of the ethmoid bone. During subsequent surgery to rid the residual tumor, manipulation near the optic nerve stump caused his heart rate to drop from 70 to 20 beats per minute. It returned to 60 beats per minute once manipulation was discontinued. Another episode of 20 beats per minute was observed with challenge manipulation . Post operative 12-lead cardiogram and cardiac enzymes were normal.
Conclusion
This is the first report of controlled stimulation of the oculocardiac reflex during surgical manipulation of a previously exenterated orbit. The reflex is mediated by neural connections between the parasympathetic system of the trigeminal and vagus nerves. Stretch- receptor stimulation usually occurs from traction of the extraocular muscles or pressure on the globe. In this case, manipulation of the ciliary ganglion ,which lies lateral to the optic nerve just anterior to the optic foramen stimulated the stretch receptors. Ophthalmologist who manage anophthalmic patients, ocularists who fit prosthetics and anophthalmic patients who experience nausea or faintness during insertion and removal of the prosthesis need to be aware of this phenomenon and take precautions against this potentially fatal condition. .
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| James | Heitz MD | Thomas Jefferson University Hospital |
| James | Tsai MD | Thomas Jefferson University Hospital |
