How to perform an ocular cephalic (Ocular Cephalic Reflex) reflex?

From the Guidelines

The oculocephalic reflex, also known as the doll's eye reflex, should be performed by rotating the patient's head horizontally or vertically while observing eye movement, as described in the pediatric eye evaluations preferred practice pattern 1. To perform this test, first ensure the patient has no cervical spine injury.

• Hold the patient's eyelids open with your fingers
• Quickly but gently rotate their head from side to side (horizontal plane) or up and down (vertical plane) In a normal response, the eyes will move in the opposite direction of head movement, maintaining their position in space.
• For example, when turning the head to the right, the eyes should move to the left. This reflex is intact in conscious patients and in those with intact brainstem function. An abnormal response (eyes moving with the head or not moving at all) suggests brainstem dysfunction. The OCR works because the vestibulo-ocular pathways in the brainstem coordinate eye movements in response to head position changes, helping maintain visual fixation, and can be used to test eye movements in infants and children, as part of a comprehensive eye evaluation 1. Key points to consider when performing the oculocephalic reflex include:
• Using accommodative targets for primary gaze at distance and near
• Testing ocular versions and ductions, including into the oblique fields of gaze
• Assessing spontaneous eye movements in the inattentive or uncooperative child
• Performing binocular alignment testing before cycloplegia, as alignment may change after cycloplegia 1.

From the Research

Ocularcephaloc Reflex Testing

To perform the ocularcephaloc reflex test, also known as the doll's eyes test, the following steps can be taken:

• The patient's head is raised 30 degrees above horizontal and rapidly rotated in the horizontal and vertical planes 2
• The conjugate eye movement is observed during this rotation 2
• The test can be used to assess the vestibulo-ocular reflex (VOR) and diagnose vestibular lesions 3
• The test is more sensitive in diagnosis of complete vestibular lesions than head-shaking nystagmus, rotatory directional preponderance, and spontaneous nystagmus 3

Interpretation of Results

The results of the ocularcephaloc reflex test can be interpreted as follows:

• In normal awake patients, the eyes will move in the direction opposite to the head rotation 4
• In stuporous or unconscious patients, the response may be absent or abnormal 4
• The suppression of the oculocephalic reflex is a normal part of maturation in infants, with 75% of babies suppressing the reflex by 11.5 weeks and more than 95% suppressing it by 20 weeks 2

Neuroanatomy and Neurophysiology

The ocularcephaloc reflex is mediated by the vestibulo-ocular system, which includes:

• The vestibular commissure 5
• The cerebellum 5
• The vestibular efferent neurons 5
• The extraocular muscles 5 The test can provide insights into the function of the vestibular system and the processing of raw vestibular signals in three dimensions 5