ORBITAL MASS IN A CHILD CAUSING SOMNOLENCE, NAUSEA AND BRADYCARDIA

Purpose: To highlight the need for referral and prompt intervention wh en signs of increased intraorbital pressure sure are present. Clinical features: A four year old child presented to hospital with orbital sw elling 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;he ha d lost responsiveness oi her left pupil to light, Anaesthetic manageme nt was highlighted by the presence of preoperative signs and symptoms of increased intraocular pressure - somnolence, nausea and vomiting, a nd bradycardia. these signs and symptoms were alleviated postoperative ly. Conclusion: Rapid onset of orbital swelling with physiological sig ns of increased orbital pressure necessitate urgent surgical intervent ion. It is possible that early referral and surgery could have preserv ed some functional vision in a situation where the light reflex remain ed in the affected eye. Alleviation of preoperative nausea and vomitin g, bradycardia, and somnolence indicates that the preoperative symptom atology was related to vagal stimulation from increased intraocular pr essure, usually identified an oculocardiac reflex.