From the Guidelines
Oculogyric crisis is a medical emergency that requires immediate treatment with anticholinergic or antihistaminic medications to prevent potential life-threatening complications, such as laryngospasm, and to alleviate distressing symptoms. The condition is characterized by sudden, involuntary upward deviation of the eyes, often accompanied by neck extension and facial grimacing, typically occurring as an adverse reaction to certain medications, particularly antipsychotics and antiemetics that block dopamine receptors 1. Key factors that increase the risk of developing oculogyric crisis include young age, male gender, and the use of high-potency agents, as noted in the practice parameter for the assessment and treatment of children and adolescents with schizophrenia by the American Academy of Child and Adolescent Psychiatry 1. Some of the key points to consider in the management of oculogyric crisis include:
- Immediate administration of anticholinergic medications, such as diphenhydramine or benztropine, to resolve symptoms
- Discontinuation or reduction of the causative medication to prevent future episodes
- Consideration of alternative medications with lower risk of extrapyramidal side effects
- Use of the lowest effective dose of high-risk medications to minimize the risk of oculogyric crisis
- Potential benefits of prophylactic anticholinergic therapy for patients with previous episodes, although this approach requires careful consideration of the individual patient's risk factors and medical history. The underlying pathophysiology of oculogyric crisis involves dopamine blockade in the basal ganglia, which disrupts the normal balance between dopamine and acetylcholine, leading to cholinergic predominance and abnormal eye movements, as described in the context of dystonic reactions, including oculogyric crisis, by the American Academy of Child and Adolescent Psychiatry 1.
From the Research
Definition and Characteristics of Oculogyric Crisis
- Oculogyric crisis (OGC) is an acute dystonic reaction characterized by sustained dystonic, conjugate, and upward deviation of the eyes 2
- It is a form of acute dystonia that can be caused by various factors, including medications, movement disorders, metabolic disorders, and focal brain lesions 2
Causes and Risk Factors of Oculogyric Crisis
- OGC is commonly associated with the administration of typical antipsychotics, and rarely reported with atypical antipsychotics 3
- Risk factors for OGC include younger age, male sex, severe illness, high neuroleptic dose, parenteral administration of neuroleptics, high potency of neuroleptic drugs, abrupt discontinuation of anticholinergic medication, and family history of dystonia 2
- OGC can also be caused by other medications, such as antiemetics, antidepressants, antiepileptics, and antimalarials 2
Treatment and Management of Oculogyric Crisis
- OGC generally responds to oral anticholinergics, but in some cases, dose reduction or discontinuation of the antipsychotic agent and switching to safer alternatives or clozapine may be required 3
- Treatment strategies for chronic OGC include high potency antipsychotics and anticholinergics drugs for immediate relief and clozapine as a long-term treatment strategy 4
- Reduction in dosage or withdrawal of the apparent causing agent can also be effective in managing OGC 5
Clinical Implications and Diagnostic Considerations
- OGC can adversely impact the compliance and prognosis of the primary illness, and therefore needs to be managed at earlier stages with appropriate medication 2
- Differential diagnoses must be taken into account when OGC is the reason for visiting, in order to avoid unnecessary studies and to carry out an appropriate therapeutic management 5