Abstract
Purpose
To highlight the need for referral and prompt intervention when signs of increased intraorbital pressure are present.
Clinical features
A four year old child presented to hospital with orbital swelling of recent onset, nausea and somnolence. Computed tomography and brain scan demonstrated a normal brain with a mass in the left orbit. She was referred for ophthalmic surgery the following day, when she had lost responsiveness of her left pupil to light. Anaesthetic management was highlighted by the presence of preoperative signs and symptoms of increased intraocular pressure — somnolence, nausea and vomiting, and bradycardia. These signs and symptoms were alleviated postoperatively.
Conclusion
Rapid onset of orbital swelling with physiological signs of increased orbital pressure necessitate urgent surgical intervention. It is possible that early referral and surgery could have preserved some functional vision in a situation where the light reflex remained in the affected eye. Alleviation of preoperative nausea and vomiting, bradycardia, and somnolence indicates that the preoperative symptomatology was related to vagal stimulation from increased intraocular pressure, usually identified as an oculocardiac reflex.
Résumé
Objectif
Souligner la nécessité d’une intervention spécialisée et rapide lorsque des signes d’accroissement de la pression intra-orbiraire sont présents.
Aspects cliniques
Une enfant de quatre ans s’est présentée à l’hôpital souffrant d’un œdème orbitaire d’apparition récente, de nausées et de somnolence. La tomodensitométrie et la scintigraphie cérébrale ont montré un cerveau normal, mais une masse dans l’orbite gauche. La fillette a été dirigée en chirurgie ophtalmique le lendemain, alors que sa pupille gauche ne réagissait plus à la lumière. Les modalités de l’anesthésie ont été dictées par la présence des signes et des symptômes préopératoires de l’accroissement de la pression intraoculaire: somnolence, nausées, vomissements et bradycardie. Ces signes et symptômes se sont atténués après l’intervention.
Conclusion
Le début rapide de l’œdème orbitaire accompagné des signes physiologiques de l’augmentation de pression intraoculaire nécessitent une chirurgie d’urgence. Il est possible que l’examen spécialisé et la chirurgie précoces aient pu préserver, en partie, la vision fonctionnelle dans des circonstances où le réflexe pupillaire était conservé dans l’oeil touché. Le soulagement des nausées, des vomissements, de la bradycardie et de la somnolence préopératoires indique que la symptomatologie était reliée à une stimulation vagale provenant de la pression intraoculaire accrue, habituellement identifiée comme étant un réflexe oculocardiaque.
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Westerling, D., Blohmé, J. & Stigmar, G. Orbital mass in a child causing somnolence, nausea and bradycardia. Can J Anaesth 45, 777–780 (1998). https://doi.org/10.1007/BF03012148
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DOI: https://doi.org/10.1007/BF03012148