Different Onset Pattern of Oculocardiac Reflex in Pediatric Medial Wall Blowout Fractures

Purpose: We report the 2 pediatric patients who had radiographic confirmation of a rare case of medial orbitalwall "trapdoor" fracture with extraordinary symptoms of oculocardiac reflex (OCR). Methods: This was a small interventional case series. Results: This is the retrospective report of 2 boys (13 and 10 years old) who developed diplopia, pain, nausea/vomiting, and general malaise following blunt trauma. However, the onset pattern of OCR was absolutely different: delayed onset of OCR just following therapeutic forced duction test to treat the orbital content herniation in the first case and a sudden onset after injury in the second case. In both cases, urgent surgery led to complete normalization of ocular motility. Conclusions: Prompt diagnosis and proper treatment are critical to maximize clinical outcome for this rare and critical trauma.