[Oculocardiac reflex associated with orbital floor fracture; the value of a reliable patient history]

Abstract

Background: The oculocardiac reflex presents when traction is applied to ocular muscles or on compression of the eyeball in the orbit. It is a vasovagal reaction that may be accompanied by bradycardia, nausea and vomiting.

Case description: A 6-year-old boy presented with vomiting and acute pain in his right eye, but no history of trauma. On physical examination we found no abnormalities other than bradycardia. Ocular examination showed an elevation restriction and slight depression restriction as well as ptosis of the affected eye. A cerebral MRI scan showed a blow-out fracture of the orbital floor with herniation of the inferior rectus muscle. The oculocardiac reflex explained the bradycardia and vomiting. Later, the boy told us that he had in fact hit his eye with his own knee.

Conclusion: When patients present with acute pain in the eye and vasovagal symptoms, the oculocardiac reflex that can accompany a fracture of the orbital floor should be considered. The early recognition and treatment of this fracture are necessary to prevent permanent motility restrictions of the eye. A patient's history is not always reliable and should not limit a differential diagnosis.