Systolic propulsion of the eyeballs in severe tricuspid regurgitation: a case series and review of the literature.

Objectives: Severe tricuspid regurgitation (TR) can be a phenotypic manifestation of an underlying disease process that is the primary driver of patient prognosis. Associated clinical signs such as small vein pulsations are similarly prognostic. Systolic propulsion of the eyeballs is an extreme manifestation of severe TR with only seven reported cases in the literature. We herein report two additional cases, review the available literature, and discuss prognostic implications of this phenomenon. Case presentation: Two patients with severe tricuspid regurgitation and systolic propulsion of the eyeballs are described in a comprehensive manner. Unlike previous reports, we include contemporary high-quality images and video of the phenomenon in addition to the most in-depth review of the literature on this subject to date. Conclusions: Systolic propulsion of the eyeballs is a manifestation of severe tricuspid regurgitation in the background of profound right ventricular dysfunction. We believe this is a rare clinical sign that carries ominous prognostic implications.