TY - JOUR
T1 - Oculocardiac reflex
T2 - An underrecognized but important association with orbital trap door fractures
AU - Mehmood, Noormah
AU - Hasan, Ali
N1 - Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Blowout fractures of the floor of the orbit can serve as a “trap door” for extraocular muscles. Presentation of inferior orbital muscle entrapment classically involves an upward gaze restriction. Diplopia and exophthalmos can also be present. Rarely, orbital fractures can result in an oculocardiac reflex, which is a triad of bradycardia, syncope, and nausea. The purpose of this study was to describe a patient who had orbital floor fracture with symptoms highly suggestive for oculocardiac reflex after a traumatic injury. Although entrapment of extraocular muscles does require early intervention to prevent ischemia and tissue necrosis, the presence of oculocardiac reflex warrants emergent evaluation and management by an ophthalmologist due to the risk of developing arrhythmias. Frequently, there may be none or very subtle clinical findings present, and abnormal motility may be the only apparent clinical sign, which can be difficult to assess in very young and uncooperative children; therefore, a high index of suspicion must be maintained for early identification and management as well as a reduction of complications.
AB - Blowout fractures of the floor of the orbit can serve as a “trap door” for extraocular muscles. Presentation of inferior orbital muscle entrapment classically involves an upward gaze restriction. Diplopia and exophthalmos can also be present. Rarely, orbital fractures can result in an oculocardiac reflex, which is a triad of bradycardia, syncope, and nausea. The purpose of this study was to describe a patient who had orbital floor fracture with symptoms highly suggestive for oculocardiac reflex after a traumatic injury. Although entrapment of extraocular muscles does require early intervention to prevent ischemia and tissue necrosis, the presence of oculocardiac reflex warrants emergent evaluation and management by an ophthalmologist due to the risk of developing arrhythmias. Frequently, there may be none or very subtle clinical findings present, and abnormal motility may be the only apparent clinical sign, which can be difficult to assess in very young and uncooperative children; therefore, a high index of suspicion must be maintained for early identification and management as well as a reduction of complications.
KW - Oculocardiac reflex
KW - Orbital muscle entrapment
KW - Trap door fracture
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U2 - 10.1097/PEC.0000000000001884
DO - 10.1097/PEC.0000000000001884
M3 - Article
C2 - 31389903
AN - SCOPUS:85120989739
SN - 0749-5161
VL - 37
SP - E1731-E1732
JO - Pediatric emergency care
JF - Pediatric emergency care
IS - 12
ER -