Oculogyric crisis is an acute dystonic reaction of the
ocular muscles characterized by bilateral dystonic elevation of visual gaze
lasting from seconds to hours. This reaction is most commonly explained as an
adverse reaction to drugs such as antiemetics, antipsychotics, antidepressants,
antiepileptics, and antimalarials.
Initial symptoms include restlessness, agitation, malaise,
or a fixed stare followed by the more characteristically described maximal
upward deviation of the eyes in the sustained fashion. The eyes may also
converge, deviate upward and laterally, or deviate downward. The most
frequently reported associated findings are backwards and lateral flexion of
the neck, widely opened mouth, tongue protrusion, and ocular pain. A wave of
exhaustion follows some episodes. The abrupt termination of the psychiatric
symptoms at the conclusion of the crisis is most striking.
Causes or triggering factors in OGC include: neuroleptics,
amantadine, benzodiazepines, carbamazepine, chloroquine, cisplatin, diazoxide,
influenza vaccine, levodopa, lithium, metoclopramide, nifedipine,
pemoline, phencyclidine, reserpine, tricyclics, postencephalitic
Parkinson's, Tourette's syndrome, multiple sclerosis, neurosyphilis, head
trauma, bilateral thalamic infarction, lesions of the fourth ventricle, cystic
glioma of the 3rd ventricle, herpes encephalitis, and juvenile
Parkinson's
Treatment in the acute phase involves reassurance and
treatment with Cogentin (IV or MI) and/or Benadryl (diphenhydramine)
and/or Diazepam or lorazepam. Maintenance therapy with oral forms of the above
medications or amantadine are indicated in more chronic recurrent cases. According to a journal published, procyclidine 5-10mg stat
can be given for acute dystonic reaction. From Bluebook, Procyclidine can be given 5 – 10mg stat as
a single dose, may repeat after 20mins if needed. (Max:20mg/day)
References:
MyBlueBook
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