Oculocardiac reflex

Short description: Pulse rate connected with eye muscles

The oculocardiac reflex, also known as Aschner phenomenon, Aschner reflex, or Aschner–Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball.[1] It is part of a broader family of reflexes known collectively as the trigeminocardiac reflex.[2]

## Contents

* 1 Prevalence
* 2 Neurophysiology
* 3 Treatment
* 4 In psychology
* 5 See also
* 6 References
* 7 External links

## Prevalence

This reflex is especially sensitive in neonates and children, particularly during strabismus correction surgery.[3] Oculocardiac reflex can be profound during eye examination for retinopathy of prematurity.[4] However, this reflex may also occur with adults. Bradycardia, junctional rhythm and asystole, all of which may be life-threatening,[5] can be induced through this reflex. This reflex has been seen to occur during many panfacial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve.[4]

## Neurophysiology

The reflex is mediated by nerve connections between the ophthalmic branch of the trigeminal cranial nerve via the ciliary ganglion, and the vagus nerve of the parasympathetic nervous system. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented.[6] These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent portion is carried by the vagus nerve from the cardiovascular center of the medulla to the heart, of which increased stimulation leads to decreased output of the sinoatrial node.[7]

## Treatment

The reflex can be blocked by intravenous injection of an anti-muscarinic acetylcholine (ACh) antagonist, such as atropine or glycopyrrolate. If bradycardia does occur, removal of the stimulus is immediately indicated. This often results in the restoration of normal sinus rhythm of the heart. If not, the use of atropine or glycopyrrolate will usually be successful and permit continuation of the surgical procedure. Caution should be used with fast-push, intravenous opioids and dexmedetomidine which exacerbate the bradycardia.[8] In extreme cases, such as asystole, cardiopulmonary resuscitation may be required. [citation needed]

## In psychology

A commonly used technique in the field of brainspotting called "vergence" deliberately triggers this reflex in order to calm patients.[9]

## See also

* Carotid sinus massage
* Vagal maneuver

## References

1. ↑ "The Oculocardiac Reflex: A Review". Clinical Ophthalmology 15: 2693–2725. 2021. doi:10.2147/OPTH.S317447. PMID 34194223.
2. ↑ Conti, Massimo; Traina, Giovanna; Tonlorenzi, Daniele (2026). "Mandibular extension as a trigger of the proprioceptive trigeminocardiac reflex". Turkish Journal of Medical Sciences 56 (1): 1–6. doi:10.55730/1300-0144.6131. ISSN 1300-0144. https://journals.tubitak.gov.tr/medical/vol56/iss1/2.
3. ↑ "Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children.". Anaesthesia 55 (9): 847–52. 2000. doi:10.1046/j.1365-2044.2000.01158.x. PMID 10947746.
4. ↑ 4.0 4.1 Schumacher AC, Ball M, Arnold AW, Grendahl RL, Winkle RK, Arnold RW. Oculocardiac reflex during ROP exams. Clin Ophthalmol. 2020;14:4263-4269. doi:https://doi.org/10.2147/OPTH.S288578
5. ↑ Smith R (1994). "Death and the oculocardiac reflex.". Can J Anaesth 41 (8): 760. doi:10.1007/BF03015643. PMID 7923532.
6. ↑ "Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex.". Can J Anaesth 38 (6): 757–60. 1991. doi:10.1007/BF03008454. PMID 1914059.
7. ↑ "The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited.". Brain Res Brain Res Rev 49 (3): 555–65. 2005. doi:10.1016/j.brainresrev.2005.02.005. PMID 16269319.
8. ↑ Schumacher AC, Ball M, Arnold AW, Grendahl RL, Winkle RK, Arnold RW. Oculocardiac reflex during ROP exams. Clin Ophthalmol. 2020;14:4263-4269. doi:https://doi.org/10.2147/OPTH.S288578
9. ↑ "Using Your Eyes to Conquer Mental Blocks". Association for Applied Sport Psychology. 2022-09-19. https://appliedsportpsych.org/blog/2022/09/using-your-eyes-to-conquer-mental-blocks/.

## External links

* Reflex,+Oculocardiac at the US National Library of Medicine Medical Subject Headings (MeSH)
* Video Example: Video abstract

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Nervous system physiology: neurophysiology]] - reflex

Cranial nerve|

* midbrain: Pupillary light reflex
* Accommodation reflex
pons/medulla: Jaw jerk reflex
* Corneal reflex
* Caloric reflex test/Vestibulo-ocular reflex/Oculocephalic reflex
* Pharyngeal (gag) reflex

Stretch reflexes|

* upper limb: Biceps reflex C5/C6
* Brachioradialis reflex C6
* Triceps reflex C7/C8
lower limb: Patellar reflex L2-L4
* Ankle jerk reflex S1/S2
* Plantar reflex L5-S2

Primitive reflexes|

* Galant
* Gastrocolic
* Grasp
* Moro
* Rooting
* Stepping
* Sucking
* Tonic neck
* Parachute

Superficial reflexes|

* Abdominal reflex
* Cremasteric reflex

Lists|

* general
* alphabetical
* by organ

Cardiovascular|

* Bainbridge reflex
* Bezold–Jarisch reflex
* Coronary reflex
* Diving reflex
* Oculocardiac reflex

| Baroreflex|

* Reflex bradycardia
* Reflex tachycardia

|

Respiratory|

* Churchill–Cope reflex

Other|

* Acoustic reflex
* H-reflex
* Golgi tendon reflex
* Optokinetic
* Startle response
* Withdrawal reflex (Crossed extensor reflex)
* Symmetrical tonic neck reflex

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