Ocular compression a century on: time for a thumbs-off approach?

This issue includes a study (Haneef et al. 2008) of simulated ocular compression (OC) by physicians who “routinely” performed OC during EEG examinations when syncopal episodes including breath-holding spells were suspected. The authors found that though each of those three physicians exerted a different range of pressure on a sphygmomanometer cuff when asked to use their thumbs as if the inflated cuff was the patient’s eye, the thumb pressure generated bore no relation to the physicians’ previous score of “positive” OC responses during EEGs. So it might not matter how hard you press the eyeballs if you want to elicit the oculocardiac reflex (OCR) during EEG. But should you? A brief historical overview may assist practitioners and readers.