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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 [[human eyeball|eyeball]]. The reflex is mediated by nerve connections between the [[trigeminal cranial nerve]] and the [[vagus nerve]] of the [[parasympathetic nervous system]]. The afferent tracts are derived mainly from the ophthalmic division of the trigeminal nerve, although tracts from the maxillary and mandibular division have also been documented<ref>{{cite journal | author = Lang S, Lanigan D, van der Wal M | title = Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. | journal = Can J Anaesth | volume = 38 | issue = 6 | pages = 757–60 | year = 1991 | pmid = 1914059 | doi = 10.1007/BF03008454}}</ref>. 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 oblongata|medulla]] to the heart, of which increased stimulation leads to decreased output of the [[sinoatrial node]]<ref>{{cite journal | author = Paton J, Boscan P, Pickering A, Nalivaiko E | title = The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. | journal = Brain Res Brain Res Rev | volume = 49 | issue = 3 | pages = 555–65 | year = 2005 | pmid = 16269319 | doi = 10.1016/j.brainresrev.2005.02.005}}</ref>. This reflex is especially sensitive in [[neonates]] and children, and must be monitored, usually by an [[anaesthesiologist]], during paediatric ophthalmological surgery, particularly during [[strabismus]] correction surgery<ref>{{cite journal | author = Kim H, Kim S, Kim C, Yum M | title = Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children. | journal = Anaesthesia | volume = 55 | issue = 9 | pages = 847–52 | year = 2000 | pmid = 10947746 | doi = 10.1046/j.1365-2044.2000.01158.x}}</ref>. However, this reflex may also occur with adults. [[Bradycardia]], junctional rhythm, [[asystole]], and very rarely death <ref>{{cite journal | author = Smith R | title = Death and the oculocardiac reflex. | journal = Can J Anaesth | volume = 41 | issue = 8 | pages = 760 | year = 1994 | pmid = 7923532 | doi = 10.1007/BF03015643}}</ref>, can be induced through this reflex.
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 [[human eyeball|eyeball]].<ref name="arnold2021">{{cite journal |vauthors=Robert AW | title = The Oculocardiac Reflex: A Review | journal = Clinical Ophthalmology | volume = 15 | pages = 2693–2725 | year = 2021 | pmid = 34194223 | doi = 10.2147/OPTH.S317447| pmc = 8238553 | doi-access = free }}</ref> 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 nerve|maxillary]] and [[Mandibular nerve|mandibular divisions]] of the trigeminal nerve have also been documented.<ref>{{cite journal |vauthors=Lang S, Lanigan D, van der Wal M | title = Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. | journal = Can J Anaesth | volume = 38 | issue = 6 | pages = 757–60 | year = 1991 | pmid = 1914059 | doi = 10.1007/BF03008454| doi-access = free }}</ref> 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 oblongata|medulla]] to the heart, of which increased stimulation leads to decreased output of the [[sinoatrial node]].<ref>{{cite journal |vauthors=Paton J, Boscan P, Pickering A, Nalivaiko E | title = The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. | journal = Brain Res Brain Res Rev | volume = 49 | issue = 3 | pages = 555–65 | year = 2005 | pmid = 16269319 | doi = 10.1016/j.brainresrev.2005.02.005| s2cid = 14992006 }}</ref> This reflex is especially sensitive in [[neonates]] and children, particularly during [[Strabismus surgery|strabismus correction surgery]].<ref>{{cite journal |vauthors=Kim H, Kim S, Kim C, Yum M | title = Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children. | journal = Anaesthesia | volume = 55 | issue = 9 | pages = 847–52 | year = 2000 | pmid = 10947746 | doi = 10.1046/j.1365-2044.2000.01158.x| s2cid = 1655909 }}</ref> Oculocardiac reflex can be profound during eye examination for retinopathy of prematurity.<ref name="schumacher2020">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</ref> However, this reflex may also occur with adults. [[Bradycardia]], [[junctional rhythm]] and [[asystole]], all of which may be life-threatening,<ref>{{cite journal | author = Smith R | title = Death and the oculocardiac reflex. | journal = Can J Anaesth | volume = 41 | issue = 8 | pages = 760 | year = 1994 | pmid = 7923532 | doi = 10.1007/BF03015643| doi-access = free }}</ref> can be induced through this reflex. This reflex has been seen to occur during many pan facial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve.<ref name="schumacher2020" />


==Treatment/prophylaxis==
==Treatment==


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 an [[anti-muscarinic]] [[acetylcholine]] (ACh) [[Receptor antagonist|antagonist]], such as [[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.
The reflex can be blocked by intravenous injection of an [[anti-muscarinic]] [[acetylcholine]] (ACh) [[Receptor antagonist|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.<ref>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</ref> In extreme cases, such as asystole, [[cardiopulmonary resuscitation]] may be required.


==References==
==In psychology==
A commonly-used technique in the field of [[brainspotting]] called "vergence" deliberately triggers this reflex in order to calm patients.<ref>{{cite web
⚫
{{Reflist}}
| url = https://appliedsportpsych.org/blog/2022/09/using-your-eyes-to-conquer-mental-blocks/
| title = Using Your Eyes to Conquer Mental Blocks
| date = 2022-09-19
| author = <!--Not stated-->
| website = AASP Blog
| publisher = [[Association for Applied Sport Psychology]]
| access-date = 2024-05-11
}}</ref>

==See also==
*[[Carotid sinus massage]]
*[[Vagal maneuver]]

⚫
== External links ==


⚫
==External links==
* {{MeshName|Reflex,+Oculocardiac}}
* {{MeshName|Reflex,+Oculocardiac}}
* Video Example: [https://www.youtube.com/watch?v=jgKgSfhv7o0 Video abstract] to <ref name="arnold2021" />

==References==
⚫
{{Reflist}}


{{Reflex}}
{{Reflex}}
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[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Reflexes]]
[[Category:Reflexes]]

[[de:Okulokardialer Reflex]]
[[pl:Odruch Aschnera]]
[[ru:Глазосердечный рефлекс]]
[[uk:Рефлекторна регуляція серця]]

Latest revision as of 16:31, 11 May 2024

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] 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.[2] 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.[3] This reflex is especially sensitive in neonates and children, particularly during strabismus correction surgery.[4] Oculocardiac reflex can be profound during eye examination for retinopathy of prematurity.[5] However, this reflex may also occur with adults. Bradycardia, junctional rhythm and asystole, all of which may be life-threatening,[6] can be induced through this reflex. This reflex has been seen to occur during many pan facial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve.[5]

Treatment

[edit]

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.[7] In extreme cases, such as asystole, cardiopulmonary resuscitation may be required.

In psychology

[edit]

A commonly-used technique in the field of brainspotting called "vergence" deliberately triggers this reflex in order to calm patients.[8]

See also

[edit]
[edit]

References

[edit]
  1. ^ a b Robert AW (2021). "The Oculocardiac Reflex: A Review". Clinical Ophthalmology. 15: 2693–2725. doi:10.2147/OPTH.S317447. PMC 8238553. PMID 34194223.
  2. ^ Lang S, Lanigan D, van der Wal M (1991). "Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex". Can J Anaesth. 38 (6): 757–60. doi:10.1007/BF03008454. PMID 1914059.
  3. ^ Paton J, Boscan P, Pickering A, Nalivaiko E (2005). "The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited". Brain Res Brain Res Rev. 49 (3): 555–65. doi:10.1016/j.brainresrev.2005.02.005. PMID 16269319. S2CID 14992006.
  4. ^ Kim H, Kim S, Kim C, Yum M (2000). "Prediction of the oculocardiac reflex from pre-operative linear and nonlinear heart rate dynamics in children". Anaesthesia. 55 (9): 847–52. doi:10.1046/j.1365-2044.2000.01158.x. PMID 10947746. S2CID 1655909.
  5. ^ a b 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
  6. ^ Smith R (1994). "Death and the oculocardiac reflex". Can J Anaesth. 41 (8): 760. doi:10.1007/BF03015643. PMID 7923532.
  7. ^ 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
  8. ^ "Using Your Eyes to Conquer Mental Blocks". AASP Blog. Association for Applied Sport Psychology. 2022-09-19. Retrieved 2024-05-11.
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