The Oculocardiac Reflex in Blepharoplasty Surgery

The oculocardiac reflex (OCR), a previously undescribed phenomenon in aesthetic blepharoplasty surgery, involves intraoperative bradycardia exceeding 10 percent of the preoperative heart rate or any dysrhythmia during ocular manipulation. It is a trigeminal-vagal-mediated reflex arc. The oculocardiac reflex was noted to occur in 25 of 100 patients (25 percent) undergoing blepharoplasty. A data sheet designed and distributed for use in the operating room identified a reflex-prone patient (RPP) as a young, anxious female, with a cardiac history, operated on under light anesthesia with aggressive fat pad resection. The oculocardiac reflex was more likely to occur in a reflex-prone patient during traction on the medial fat pads and in the left eye. Despite anticipating the fatigue phenomenon in those patients who exhibited a profound bradycardia (35 to 40 beats per minute), it was necessary to release traction in order to permit the heart rate to return to normal. Awareness and treatment of this potentially life-threatening oculocardiac reflex are necessary. Careful patient surveillance and monitoring are mandatory.