From the Guidelines
Doll's Eye (Oculocephalic Reflex) in Neurology
Doll's eye, also known as oculocephalic reflex, is a crucial neurological sign that evaluates the integrity of the brainstem and vestibular system [ 1 ].
- It is characterized by the movement of the eyes in the direction opposite to the rotation of the head, typically elicited by gently rotating the patient's head from side to side.
- In patients with intact brainstem function, the eyes will move conjugately in the direction opposite to the head rotation, whereas in patients with brainstem dysfunction, the eyes may not move or may move disconjugately.
- The assessment of doll's eye is an important component of the neurological examination, particularly in comatose patients, and does not require any specific medication or equipment [ 1 ].
- As part of a comprehensive neurological evaluation, doll's eye reflex is assessed alongside other brainstem reflexes, such as pupillary light response, corneal reflex, and cough/gag reflexes [ 1 ].
- The use of standardized scoring tools, like the Glasgow Coma Scale, is recommended for a systematic approach to neurological assessment [ 1 ].
From the Research
Definition and Mechanism
- The doll's eye reflex, also known as the oculocephalic reflex, represents the vestibulo-ocular reflex (VOR) elicited by high-acceleration head rotation 2.
- This reflex is responsible for stabilizing the eyes during head movements, ensuring clear vision and balance 3.
Clinical Significance
- The doll's eye reflex is used as a diagnostic test for complete vestibular lesions, and is more sensitive than other tests such as head-shaking nystagmus, rotatory directional preponderance, and spontaneous nystagmus 2.
- Impairment of the doll's eye reflex can be an indicator of various neurological conditions, including cerebellar ataxia with bilateral vestibulopathy (CABV) 4, cortical visual impairment (CVI) 5, and degenerative neurological diseases 6.
Testing and Evaluation
- The doll's eye reflex can be tested using the doll's head maneuver, which involves passive head movement during visual fixation on a moving target 6, 5.
- Electronystagmography (ENG) can also be used to evaluate the VOR function in patients with suspected vestibular lesions 2.
- Search coil oculography can be used to validate the characteristic clinical sign of impaired visually enhanced vestibulo-ocular reflex (VVOR) or doll's head reflex in patients with CABV 4.