SHM Converge Scientific Abstract ePoster Gallery-Sustained Oculocardiac Reflex in a Patient With Severe Panophthalmitis

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This case report describes a 73-year-old woman with type II diabetes who presented with severe right eye pain, vision loss, and signs of panophthalmitis. Workup showed Streptococcus pneumoniae bloodstream infection and meningitis, with MRI findings consistent with ventriculitis and widespread orbital inflammation.<br /><br />During hospitalization, she developed recurrent episodes of profound bradycardia and sinus pauses, later alternating with atrial fibrillation with rapid ventricular response. These rhythm disturbances closely coincided with elevated intraocular pressure (IOP) and severe ocular inflammation. When IOP-lowering therapy was started, her sinus pauses shortened and her bradycardia improved. When eye pressure rose again, the arrhythmias recurred. After enucleation for uncontrolled infection and pain, she no longer had bradycardia or sinus pauses.<br /><br />The authors interpret this as a likely sustained oculocardiac reflex, a trigeminal-vagal response usually seen transiently during eye manipulation but rarely reported as prolonged. Prior case reports have linked delayed or persistent bradycardia to orbital foreign bodies or globe injury. In this patient, the suspected triggers were severe intraocular and extraocular inflammation, possibly combined with external pressure from an edematous eyelid.<br /><br />The report suggests that in severe eye infections or inflammatory eye disease, elevated IOP may contribute to clinically significant arrhythmias. Lowering IOP may help control these rhythm disturbances. The authors note, however, that definitive proof of the mechanism was not possible, and other contributors such as pain-related vagal activation or meningitis-related Cushing reflex were considered less likely.

Asset Subtitle

Ashley Zhou

Meta Tag

Author List Ashley Zhou, John Bundrick, Regina Koch

Category Clinical Vignettes

Concept Oculocardiac Reflex

Concept Globe Pressure

Concept Extraocular Muscle Traction

Concept Panophthalmitis

Concept Heart Rate Reduction

Distinguished Non-Finalist

Presenter Organization The Mayo Clinic

Presenting Author Ashley Zhou

Track Adult

Keywords

panophthalmitis

oculocardiac reflex

bradycardia

sinus pauses

atrial fibrillation

elevated intraocular pressure

Streptococcus pneumoniae

meningitis

ventriculitis

enucleation

Oculocardiac Reflex

Globe Pressure

Extraocular Muscle Traction

Panophthalmitis

Heart Rate Reduction