search for


Incidence and Factors that Affect the Oculocardiac Reflex during Strabismus Surgery
Ann Optom Contact Lens 2019;18:51-56
Published online June 25, 2019
© 2019 The Korean Optometry & Contact Lens Study Society

Hyung Jun Park, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
Correspondence to: Hae Jung Paik, MD, PhD
Department of Ophthalmology,Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea
Tel: 82-32-460-3364, Fax: 82-32-460-3358
Received May 9, 2019; Revised June 15, 2019; Accepted June 17, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: To investigate incidence and factors associated with the occurrence of oculocardiac reflex (OCR) during strabismus surgery.
Methods: Three hundred eighty-seven patients who underwent strabismus operation under general anesthesia participated in this retrospective study. OCR was defined as a heart rate (HR) reduction of more than 15%, when compared to baseline HR. When OCR occurred patient were treated with intravenous atropine (15 µg/kg) or release the tension on the muscle. The incidence and preoperative and intraoperative variable factors of the OCR were investigated.
Results: An overall rate of 30.2% of the patients showed a positive OCR. There were significantly more OCR in the inferior oblique and rectus combine surgery than rectus surgery (p = 0.001), The occurrence rate of OCR within 5 minutes after operation was 88.8% in inferior oblique and rectus combine surgery and 80.0% in rectus surgery.
Conclusions: Manipulation of inferior oblique muscle in patients with two muscle surgeries in each eye was a significant risk factor for OCR occurrence. Gentle manipulation of the extraocular muscles especially the oblique muscle is important in two muscle surgeries. Surgeon and Anesthesiologist needs to be more careful within 5 minutes after surgery in strabismus surgery.
Keywords : Oculocardiac reflex; Oculomotor muscles; Risk factor; Sinus bradycardia; Strabismus surgery

December 2019, 18 (4)