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Arnold RW. The Oculocardiac Reflex: A Review. Clin Ophthalmol. 2021;15:2693-2725doi: 10.2147/OPTH.S317447.
Arnold, R. W. (2021). The Oculocardiac Reflex: A Review. Clinical ophthalmology (Auckland, N.Z.), 152693-2725. https://doi.org/10.2147/OPTH.S317447
Arnold, Robert W. "The Oculocardiac Reflex: A Review." Clinical ophthalmology (Auckland, N.Z.) vol. 15 (2021): 2693-2725. doi: https://doi.org/10.2147/OPTH.S317447
Arnold RW. The Oculocardiac Reflex: A Review. Clin Ophthalmol. 2021 Jun 24;15:2693-2725. doi: 10.2147/OPTH.S317447. eCollection 2021. PMID: 34194223; PMCID: PMC8238553.
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Clin Ophthalmol. 2021 Jun 24;15:2693-2725. doi: 10.2147/OPTH.S317447. eCollection 2021.

The Oculocardiac Reflex: A Review.

Clinical ophthalmology (Auckland, N.Z.)

Robert W Arnold

Affiliations

  1. The Alaska OCR Study, Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK, 99508, USA.

PMID: 34194223 PMCID: PMC8238553 DOI: 10.2147/OPTH.S317447

Abstract

BACKGROUND: A typical oculocardiac reflex (OCR) is a moderate trigemino-vagal bradycardia elicited by tension on an extraocular muscle (EOM) during strabismus surgery; however, many other orbital stimuli can elicit cardiac slowing including retinopathy of prematurity examination.

METHODS: World literature related to trigeminovagal and oculocardiac reflex covering over 15,000 patients including 51 randomized clinical trials and case reports are analyzed and reviewed. Under an ongoing observational trial in Alaska, anesthetic, patient and surgical influences on routine strabismus surgery using prospective, uniform EOM tension are compared seeking sufficient sample size to characterize this individually widely variable cardiac response.

RESULTS: With adequate sample size, and emphasizing clinical studies controlling type of EOM, muscle tension amount and duration, anticholinergic and opioid medications, the following augment OCR; rapid-acting opioids and dexmedetomidine while OCR is reduced in older patients, the right eye, less EOM tension, deeper inhaled agents, hypocarbia, anticholinergic medications and orbital block. In re-operations, the former are relatively poor predictors of subsequent OCR.

CONCLUSION: Profound bradycardia can occur in almost 10% of strabismus surgery cases without anticholinergic preventive measures, but reliable prediction of OCR remains elusive. With foreknowledge and careful anesthetic monitoring of the patient before EOM manipulation, residual adverse sequelae from OCR are fortunately very rare. Despite well over a century of experience, the teleology for this occasionally dramatic cardiac response to eye surgery is still not known.

© 2021 Arnold.

Keywords: asystole; bradycardia; strabismus surgery; trigeminovagal reflex

Conflict of interest statement

Financial disclosure: none related to OCR. Dr. Arnold is president and a board member of Glacier Medical Software which markets cloud-based ROP Check. He is also president and a board member of PDI Ch

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