Treatment/prophylaxis
The surgeon can prophylactically block the afferent limb of the reflex by injecting peribulbar or retrobulbar local anesthetics. The anesthesiologist can prophylactcally block or attenuate the efferent limb of the reflex with an intravenous injection of an anti-muscarinic acetylcholine (ACh) antagonist, such as atropine or glycopyrrolate. If bradycardia does occur, removal of the inciting stimulus is immediately indicated, and is essential for successful termination of this reflex. The surgeon, or practitioner, working on the eye should be asked to cease their activity and release the applied pressure or traction on the eyeball. This often results in the restoration of normal sinus rhythm of the heart. If not, the use of atropine or glycopyrrolate will likely successfully treat the patient and permit continuation of the surgical procedure. In extreme cases, such as the development of asystole, cardiopulmonary resuscitation may be required. Usually seen while applying traction on the medial rectus.
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