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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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Year : 2013  |  Volume : 20  |  Issue : 3  |  Page : 268-270

Oculocardiac reflex in a medial orbital wall fracture without clinically evident entrapment

1 Wright State University Boonshoft School of Medicine, Dayton, Ohio; The Wilmer Ophthalmological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
2 King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Surgery, Wright State University, Dayton, Ohio
3 Department of Surgery, Wright State University, Dayton, Ohio

Correspondence Address:
Timothy J McCulley
The Wilmer Eye Institute, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Baltimore, Maryland 21224, USA

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Source of Support: Supported in part by an unrestricted grant to the Wilmer Ophthalmological Institute from Research to Prevent Blindness Inc., New York, Conflict of Interest: None

DOI: 10.4103/0974-9233.114810

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In this report, we describe a patient with a medial wall orbital fracture, who presented with vasovagal-like symptoms secondary to an oculocardiac reflex. This case is unusual because the patient had no other clinical evidence of muscle entrapment. A 15-year-old male presented with daily 5-10 min episodes of dizziness, light headedness, and nausea consistent with a vasovagal reaction. On examination, the patient had full extra ocular motility and was orthotropic in all fields of gaze. On computed tomography a comminuted medial orbital wall fracture was identified. The adjacent medial rectus muscle was in normal position, but was "rounded" relative to the contralateral side. The patient underwent fracture repair with immediate resolution of all symptoms. Symptoms related to a vasovagal response may occur with orbital fractures despite normal extra ocular motility. Presumably this relates to tension or pulling on an extra ocular muscle, which is not to a degree that alteration in function is appreciable clinically.

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