OCULOCARDIAC REFLEX (OCR) has been described to occur with mechanical manipulation of the eye, eyelids or orbit. There are no reports in the literature of OCR during intravitreal injection (IVI). This may be due to the fact that heart rate is not monitored during the procedure. We aimed to evaluate OCR during IVI. A total of 532 patients were enrolled in the study at Asociacion para Evitar la Ceguera en Mexico. Mexico City, Mexico. IVI was performed on one eye in every patient with diabetic retinopathy (DR), age related macular degeneration (AMD) or choroidal neovascularization (CNV) secondary to pathological myopia. Heart rate was monitored with a pulse oximeter before, during and after injection. OCR was defined as a 20% decrease or more of basal heart rate. The population enrolled included 270 females and 262 males with mean age of 63. 8 years. A decrease in heart rate of 20% or more occurred in 18 patients during IVI (3. 3%; 95% confidence interval 1. 85% and 4. 92%). OCR was asymptomatic in these patients. OCR occurred in 3. 3% of our patients during IVI. Hence, OCR must be considered when performing IVI...

The activation of oculucardiac REFLEX (OCR) is common during the strabismus surgeries. OCR is known as a trigemino-vagal REFLEX, which leads to the various side effects including bradycardia, arrhythmia, or in some cases cardiac arrest. This REFLEX could be activated during intraorbital injections, hematomas, and mechanical stimulation of eyeball and extraocular muscles surgeries. The incidence of OCR varies in a wide range, from 14% to 90%, that depends on anesthetic strategy and drug used for the surgery. The efficacy of various anticholinergic and anesthetic agents on declining the OCR REFLEX has been evaluated in different studies, especially in children. Although the detection of OCR goes back to 1908, its exact effect is not well recognized during strabismus surgery. In this review, we aimed to summarize the studies investigated the efficacy and potential of various anesthetic medications on inhibiting the OCR in children undergoing strabismus surgery.

BACKGROUND: This study was conducted to evaluate variations in heart rate and to determine the occurrence of OCULOCARDIAC REFLEX (OCR) during laser in situ keratomileusis (LASIK). METHODS: This descriptive, prospective study was designed to observe the effect of suction ring and ablation stages during LASIK procedure on the heart rate. The ECG was taken before and during LASIK operation on the first eye in 61 patients. These patients were selected randomly among cases that presented to Al-Zahra Hospital, Isfahan, Iran for LASIK surgery in summer 2001. All patients were healthy without history of cardiovascular disease and no systemic medication. The ECG prior to the procedure was considered as baseline. Decrease in the heart rate of 10% or more of baseline was considered as OCULOCARDIAC REFLEX. RESULTS: In 12 patients (20%) the heart rate decreased more than 10% during the suction ring stage. In 19 patients (31%) the heart rate increased more than 20% of baseline. In 15 patients (25%) the heart rate increased 10%-20% more than baseline during the preparation and ablation stages. In the remaining 15 patients (25%) the heart rate did not change during the procedure. CONCLUSIONS: Results of this study confirm that OCULOCARDIAC REFLEX may occur during the LASIK procedure especially in the suction ring stage. Because the OCULOCARDIAC REFLEX may cause heart rate changes during LASIK, the patients should be closely monitored during the procedure.

Background & Objectives: OCULOCARDIAC REFLEX (OCR) is presented with bradycardia and other arrhythmias, is induced by mechanical stimulation and therefore, encountered during strabismus surgery. The aim of this study is to determine the incidence and risk factors of cardiac arrhythmias during strabismus surgery in children and adults. Methods: In this prospective, randomized and double-blind study, 46 patients ASA class I and II underwent elective strabismus surgery with general anesthesia and were allocated to one of the two groups: children under 12 and adults over 12. All patients received standard general anesthesia based on their age. Demographic data, type of involved muscle, the incidence, (type and frequency) and the cause of arrhythmias and skillfulness of the surgeon (professor-assistant) were recorded. Results: There were 26 patients in children group and 20 patients in adult group. The overall incidence of arrhythmias was 91% with 96.15% in children and 85% in adults. There was not any significant difference in the incidence of arrhythmias, and the mean rate of occurrence between two groups. Most of the arrhythmias were due to external ocular muscles traction. Conjunctival traction and pressure on the globe were the other causes. Stimulation of median rectus muscle as the most important arrythmogenic factor was seen in 13 children and 12 adults. Bradycardia and tachycardia were among common arrhythmias, but there was no significant difference between two groups (P>0.05) in terms of their incidence. Conclusion: This study showed that the incidence of arrhythmias during strabismus surgery is high in both children and adults. This REFLEX does not often lead to hemodynamic ompromise, however, for its early diagnosis and treatment, close and continuous monitoring of the  patient as well as cooperation and communication between anesthesiologist and surgeon is needed.    

Profound bradycardia during eye surgery is a potentially serious event. In clinical practice OCULOCARDIAC REFLEX (OCR) is most often encountered during squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of ketamine as an induction drug and anticholinergic premedication (atropine) to prevent OCR. This study comprised 90 patients (aged 4-10 years) operated for squint surgery under general anesthesia. Patients were divided into three groups. Using block randomization, each patient enrolled in one of the three groups based on organized random table prepared by statistician.Group K received ketamine as an induction drug, Group A was premedicated with intravenous injection of atropine and Group C did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. The observed data showed occurrence of 63% OCR in Group C as compared to 43% in group A and only 20% in Group K. Current study showed that induction with ketamine in the patients of squint surgery under general anesthesia definitely obtunds OCR and prevents any untoward effects of dysrhythmias during eye surgery.

Background: OCULOCARDIAC REFLEX (OCR) is a life threatening, possible complication of corrective strabismus surgery and is more common among the pediatric patients. Sevoflurane and Propofol are the most commonly used agents in pediatric surgery. This study aimed to compare the effect of these two agents on OCULOCARDIAC REFLEX during corrective strabismus surgery in pediatrics patients. Materials and Methods: A total of 89 children were divided in two groups and no significant demographic data difference was between the two groups. Group 1 (n=45) received sevoflurane 6-8% as induction agent followed by 2-3% for maintenance, group 2 (n=44) was injected with propofol 3mg/kg as induction agent followed by 200μ g/kg/min infusion as the maintenance dose, bispectral index (BIS) was kept 40-60 in both groups. OCULOCARDIAC REFLEX was compared between the two groups. Results: Incidence of OCR of group 1was showed a significant decrease. Conclusion: Sevoflurane reduced the incidence of OCR. Sevoflurane may be the agent of choice in corrective strabismus surgery, compared to propofol.