Asaari Sabrina Abu Hassan, Balasubramaniam Dharshini, Ramli Norlina, Ismail Fazliana
Universiti Malaya Eye Research Centre, Department of Ophthalmology, Universiti Malaya, Kuala Lumpur, Malaysia.
Am J Ophthalmol Case Rep. 2024 Feb 29;34:102029. doi: 10.1016/j.ajoc.2024.102029. eCollection 2024 Jun.
To report a case of oculocardiac reflex following penetrating orbital injury with entrapment of extraocular muscle secondary to a retained orbital foreign body.
A 19-year-old man with no known comorbidities presented with a foreign object in his right orbit following a motor vehicle accident. Visual acuity was 20/20 bilaterally with positive relative afferent pupillary defect for the right eye. A motorcycle brake lever was embedded in the right inferotemporal conjunctival fornix, missing his globe. He was bradycardic in the emergency department, with a pulse rate ranging between 45 and 48 beats per minute. An urgent computed tomography scan of the orbit confirmed the penetrating injury with a linear hyperdense foreign body extending from the right inferior orbit into the right maxillary sinus. This foreign body was seen abutting the right lateral rectus and the globe inferiorly. Fractures involving the inferior and medial wall of the right orbit were seen with the inferior rectus, and orbital fat herniated into the maxillary sinus.The patient underwent urgent orbit exploration with foreign body removal and orbital floor repair under general anesthesia. Immediately after removing the foreign body, his pulse rate returned to normal, within 72-80 beats per minute. Six months postoperatively, visual acuity was 20/20 for both eyes. Although he had persistent diplopia on upgaze, he refused any other interventions.
Prompt detection of the oculocardiac reflex and removal of the inciting stimulus is vital to prevent any life-threatening events.
报告1例因眼眶穿透伤伴眶内异物残留继发眼外肌嵌顿而引发眼心反射的病例。
一名19岁无已知合并症的男性在机动车事故后右眼眶内有异物。双眼视力均为20/20，右眼相对传入性瞳孔障碍阳性。一个摩托车制动杆嵌入右颞下结膜穹窿，未伤及眼球。他在急诊科时心率缓慢，脉搏率在每分钟45至48次之间。眼眶紧急计算机断层扫描证实存在穿透伤，有一线状高密度异物从右眼眶下部延伸至右上颌窦。可见该异物紧邻右侧外直肌和眼球下部。右眼眶下壁和内侧壁骨折，下直肌受累，眶脂肪疝入上颌窦。患者在全身麻醉下接受了紧急眼眶探查、异物取出和眶底修复手术。取出异物后，他的脉搏率立即恢复正常，在每分钟72至80次之间。术后6个月，双眼视力均为20/20。尽管他上视时仍有持续性复视，但拒绝任何其他干预措施。
及时发现眼心反射并去除刺激源对于预防任何危及生命的事件至关重要。
