When you’re suspicious of entrapment in an orbital floor blowout fracture following trauma, do you ask your patients to look up, to check for diplopia. Do you cardiac monitor them when you do this?
Patients with no diplopia, with an orbital floor blowout fracture, are assumed to have no entrapment. However, even with no diplopia, the oculocardiac reflex can identify a group of patients that still require surgical intervention. It is a rare finding, but one to know.
We discussed the oculocardiac reflex in this blog back in January of 2014 in an article titled; Aschner phenomenon in traumatic enucleation of the eye. In that case a 35 yo patient presented following being stabbed in the eye with a stick. The patient presented with loss of vision in the eye and profound bradycardia.
The Aschner phenomenon, which is due to the oculocardiac reflex, is mediated by the vagus nucleus and leads to the negative chronotropic effects on the heart, resulting in bradycardia, which may be so significant, that syncope occurs.
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