The oculocardiac reflex may occur when there is stimulation of the ophthalmic branch of the fifth cranial nerve, such as with traction on an extraocular muscle. This results in vagal stimulation, which may be followed by bradycardia or other cardiac changes.


Conditions when encountered:

(1) fracture of the orbital floor (blowout fracture) with white-eye, usually in adolescents (age < 18 years). The eye becomes trapped in the defect and the reflex is triggered when the patient tries to move the eye.

(2) during strabismus surgery, when there is traction on an extraocular muscle (EOM)

(3) instillation of local anesthetic within the orbit


Clinical findings:

(1) nausea and vomiting

(2) bradycardia

(3) syncope

(4) heart block


Cardiac arrest may occur if the cause is not corrected.


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