Oculocardiac Reflex in an Orbital Fracture without Entrapment

Abstract Large orbital fractures in older patients are infrequently associated with an exaggerated oculocardiac reflex. We present a patient in their 5th decade with a large right orbital floor and medial wall fracture without radiographic evidence of extraocular muscle compression or entrapment who experienced severe nausea and bradycardia with movement of his affected eye. The patient exhibited bradycardia to 17 beats per minute during the initial examination and was taken emergently to the OR for reconstruction of the right orbital floor and medial wall. Additional episodes of bradycardia intraoperatively were responsive to glycopyrrolate. After the procedure, the patient’s pain was reduced, a normal range of motion was restored, and the bradycardia and nausea resolved. An explanation for induction of the oculocardiac reflex is considered in the absence of clinical or radiological entrapment as large orbital fractures are not often considered to induce this reflex.