Vasovagal episodes (syncope) are common, usually benign, events. These reactions are centered around the “fight or flight” response, such as when a person experiences a perceived or actual danger or threat. Common scenarios that can trigger a vasovagal attack in an ophthalmology office include dilation, applanation tonometry, contact lens insertion, and foreign body removal. Often, the patient has premonitory signs and symptoms before the episode; these include lightheadedness, nausea, the sensation of changes in temperature, or tinnitus. Physiologically, during an episode the vagus nerve is stimulated, causing peripheral blood vessels to dilate, which lowers blood pressure and slows the heart rate. Cerebral hypoperfusion and subsequent loss of consciousness can occur. Fortunately, these episodes are short-lived; the patient typically recovers within seconds. If these episodes occur in older persons, cardiac abnormalities should be considered. Patients with a history of cardiac problems who experience a syncopal episode have a higher risk of morbidity and mortality and should be evaluated thoroughly. A person experiencing a syncopal episode should be placed supine—preferably in a cool, quiet place—and the legs should be elevated.
Video 16-2 depicts the management of a vasovagal episode in the office setting.
Management of a vasovagal episode.
Courtesy of A. Luisa Di Lorenzo, MD.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.