ReviewClinical ophthalmology (Auckland, N.Z.)2021
The Oculocardiac Reflex: A Review.
Review in Clinical ophthalmology (Auckland, N.Z.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04353960 (The Alaska Oculocardiac Reflex Study), which is not on this map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Alaska Oculocardiac Reflex Study
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Life-threatening complications in ophthalmic surgery: a systematic review.Eye (London, England) · 2025Pooled it
- The preventive effect of dexmedetomidine on anesthesia complications in strabismus surgery: a systematic review and meta-analysis.BMC anesthesiology · 2023Pooled it
- Oculocardiac reflex during endoscopic brow lift: A case report.JPRAS open · 2026Article
- Sinus bradycardia after intravenous methylprednisolone pulse therapy in patients with thyroid-associated ophthalmopathy.Frontiers in pharmacology · 2026Article
- Oculocardiac Reflex During Strabismus Surgery: Conjunctival Incision versus Standardized Rectus Muscle Traction.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Exploring the correlation between dental procedures and trigemino-cardiac reflex.Journal of dental sciences · 2025Article
- The Infratrochlear Nerve Block Reduces the Incidence of Postoperative Nausea Vomiting in Pediatric Patients Undergoing Strabismus Surgery-A Retrospective Study.Biomedicines · 2025Article
- Pediatric and Juvenile Strabismus Surgery Under General Anesthesia: Functional Outcomes and Safety.Journal of clinical medicine · 2025Article
- Clinical Impact of Specific Extraocular Muscle Manipulation and the Oculocardiac Reflex on Postoperative Vomiting in Pediatric Strabismus Surgery: A Multicenter, Observational Study.Paediatric anaesthesia · 2025Observational
- Comparison of Rocuronium and Cisatracurium in Ophthalmic Surgeries in Association with the Incidence of Intraoperative Bradycardia- A Retrospective Study.Drug design, development and therapy · 2025Article
- Administration of Nicotine Can Inhibit Myopic Growth in Animal Models.Investigative ophthalmology & visual science · 2024Article
- When brakes fail you: Oculocardiac reflex elicited by a retained foreign body in a penetrating orbital injury.American journal of ophthalmology case reports · 2024Article
- Oculocardiac Reflex in a Patient With Maxillofacial Trauma: A Case Study and Literature Review.Cureus · 2024Article
- The role of surgical factors eliciting oculocardiac reflex of patients undergoing orbital tumor surgery: a retrospective study.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2024Article
- Tongue-in-Groove: A Novel Implant Design for a Blow-Out Fracture.Journal of clinical medicine · 2024Article
- Cardiovascular Reflexes - Vagus as the Key Player.Current cardiology reviews · 2024Review
- Comparing Effectiveness and Safety of Intravenous Atropine with Topical Tetracaine in Preventing and Relieving Oculocardiac Reflex in Patients Undergoing Strabismus Surgery: A Randomized Clinical Trial.Advanced biomedical research · 2024Article
- A Comparison of the Intrarectal and Intramuscular Effects of a Dexmedetomidine, Ketamine and Midazolam Mixture on Tear Production in Cats: A Randomized Controlled Trial.Animals : an open access journal from MDPI · 2023Article
- TransOrbital NeuroEndoscopic Surgery for Biopsy of the Left Cavernous Sinus: A Literature Review, Case Report, and Cadaveric Proof of Concept.Journal of neurological surgery reports · 2023Article
- The Oculocardiac Reflex: A Rare but Significant Cardiovascular Complication During Percutaneous Sclerotherapy of a Retro-Bulbar Low Flow Venolymphatic Malformation.Cardiovascular and interventional radiology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA typical oculocardiac reflex (OCR) is a moderate trigemino-vagal bradycardia elicited by tension on an extraocular muscle (EOM) during strabismus surgery; however, many other orbital stimuli can elicit cardiac slowing including retinopathy of prematurity examination.
methodsWorld literature related to trigeminovagal and oculocardiac reflex covering over 15,000 patients including 51 randomized clinical trials and case reports are analyzed and reviewed. Under an ongoing observational trial in Alaska, anesthetic, patient and surgical influences on routine strabismus surgery using prospective, uniform EOM tension are compared seeking sufficient sample size to characterize this individually widely variable cardiac response.
resultsWith adequate sample size, and emphasizing clinical studies controlling type of EOM, muscle tension amount and duration, anticholinergic and opioid medications, the following augment OCR; rapid-acting opioids and dexmedetomidine while OCR is reduced in older patients, the right eye, less EOM tension, deeper inhaled agents, hypocarbia, anticholinergic medications and orbital block. In re-operations, the former are relatively poor predictors of subsequent OCR.
conclusionProfound bradycardia can occur in almost 10% of strabismus surgery cases without anticholinergic preventive measures, but reliable prediction of OCR remains elusive. With foreknowledge and careful anesthetic monitoring of the patient before EOM manipulation, residual adverse sequelae from OCR are fortunately very rare. Despite well over a century of experience, the teleology for this occasionally dramatic cardiac response to eye surgery is still not known.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.