Oculocephalic reflex:
- ensure the C-spine is cleared.
- the patient’s eyes are held open.
- the head is briskly turned from side to side with the head held briefly at the end of each turn.
- a positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brainstem (CN3,6,8) ...
- a similar result is seen when the head is flexed and extended — a positive result is downward deviation of the eyes during extension, and upward ...
- The eyes should gradually return to the mid-position in a smooth, conjugate movement if the brainstem is intact.
What is the oculocephalic reflex?
Oculocephalic reflex: ensure the C-spine is cleared. the patient’s eyes are held open. the head is briskly turned from side to side with the head held briefly at the end of each turn. a positive response occurs when the eyes rotate to the opposite side to the direction of head rotation, thus indicating that the brainstem (CN3,6,8) is intact.
How are vertical oculovestibular eye responses assessed?
Vertical oculovestibular eye responses can be assessed by irrigating both ears simultaneously. If the brainstem is intact, cold water causes the eyes to deviate downwards and warm water causes the eyes to deviate upwards. The positive brainstem responses described above are those seen in a comatose patient with an intact brainstem.
What is the oculocephalic reflex in metabolic coma?
Patients with metabolic coma (e.g. hepatic failure) may have exaggerated, brisk oculocephalic reflexes. the head is elevated to 30 degrees above horizontal so that the lateral semicircular canal is vertical, and so that stimulation with generate a maximal response.
How do you assess the effectiveness of retrobulbar anesthesia?
Using the oculocephalic reflex to assess effective retrobulbar anesthesia. [Ophthalmic Surg. 1993] Using the oculocephalic reflex to assess effective retrobulbar anesthesia.
How do you elicit dolls eye reflex?
Typically the doll's eyes reflex is elicited by turning the head of the unconscious patient while observing the eyes. The eyes will normally move as if the patient is fixating on a stationary object. If there is a negative doll's eyes reflex then the eyes remain stationary with respect to the head.
What is the meaning of oculocephalic reflex?
The oculocephalic reflex (doll's eyes reflex) is an application of the vestibular-ocular reflex (VOR) used for neurologic examination of cranial nerves 3, 6, and 8, the reflex arc including brainstem nuclei, and overall gross brainstem function.
How do you test for vestibulo ocular reflex?
VOR is generally tested by turning the patient's head on their long axis and observing for the doll's eyes response (DOLL). The eyes deviate opposite to the direction of head rotation. A possibly related maneuver has been used in infants as a neurologic test.
What does a negative DOLL's eye reflex mean?
Negative Doll's eyes would stay fixed midorbit, so having negative "doll's eyes" is a sign that a comatose patient's brainstem is not intact. There is one very important contraindication of this examination - trauma of a cervical spine - because we could seriously injured patient.
How is the corneal reflex tested?
Approaching his eye from the side, out of his line of vision, lightly touch a thin strand of clean cotton (as from a cotton ball) to his cornea. Observe for blinking and tearing in that eye (direct corneal reflex). At the same time, observe whether his other eye blinks (consensual corneal reflex).
How do you do a cold caloric test?
A small amount of cold water or air is gently delivered into one of your ears. Your eyes should show an involuntary movement called nystagmus. Then they should turn away from that ear and slowly back. If water is used, it is allowed to drain out of the ear canal.
How do you perform a vestibular test?
During the test, your eye movements are recorded with electrodes that are placed near the eyes as you sit in a computerized chair that moves. A rotary chair test can measure your responses to head movements that are similar to the speed you will perform daily activities.
What is normal vestibulo-ocular reflex?
The rotational vestibulo-ocular reflex (rVOR) produces a slow-phase eye movement that compensates for horizontal (yaw), vertical (pitch) or torsion (roll) head rotations. The normal rVOR is perfectly compensatory in direction and speed during yaw and pitch head rotations.
What is a vestibular function test?
Vestibular function tests are performed to assess the inner ear balance organs and to identify if one or both are working properly. Part of this will involve close observation and recording of your eyes movements to look for nystagmus.
Is positive doll's eyes normal?
If reflex deviations of the eyeballs of the examined person occur in the direction opposite to turning the head, a positive doll's eyes reflex is diagnosed. If the doctor suspects damage to the stem structures, a negative test result is diagnosed.
What is doll's head maneuver?
USA. Synonyms. Doll's eye movement; Oculocephalic reflex. Definition. The doll's eye maneuver is executed by quickly turning the patient's head horizontally from side to side or vertically up and down while holding the eyelids open.
What does doll's eye response mean?
doll's eye phenomenon (reflex) the movement of the eyes as a unit in the opposite direction when the head is moved; it occurs in an individual with a depressed level of consciousness when cranial nerves three and six are intact. Called also oculocephalic reflex.
What does positive doll's eyes mean?
The examiner observes a positive oculocephalic reflex when the patient moves their eyes opposite of the rotation of their head, such that their eyes stay looking forward (like a doll's eyes).
What are brain stem reflexes?
Brainstem reflexes are relatively simple motor responses organized by the brainstem and designed to enable the body to adjust rapidly to sudden changes in the environment.
Which nerves are involved in the corneal reflex?
The corneal blink reflex is caused by a loop between the trigeminal sensory nerves and the facial motor (VII) nerve innervation of the orbicularis oculi muscles. The reflex activates when a sensory stimulus contacts either free nerve endings or mechanoreceptors within the epithelium of the cornea.
What does conjugate gaze mean?
Conjugate gaze is the ability of the eyes to work together or in unison. It refers to the motion of both eyes in the same direction at the same time. The eyes can look laterally (left/right), upward, or downward. Disorders in conjugate gaze refer to the inability to look in a certain direction with both eyes.
How to perform oculocephalic reflex?
The oculocephalic reflex is performed by holding a patient’s eyelids open and moving their head from side to side. The examination should only be performed on patients with a stable cervical spine without c-spine precautions.
What is the oculocephalic reflex?
The oculocephalic reflex (doll's eyes reflex) is an application of the vestibular-ocular reflex (VOR) used for neurologic examination of cranial nerves 3, 6, and 8, the reflex arc including brainstem nuclei, and overall gross brainstem function. It is often used to examine patients in the neurologic critical care setting and may have utility ...
What is the significance of doll's eyes reflex?
There are several areas of clinical practice where the doll's eyes reflex has significance: Vestibular lesions - Lesions to the vestibular nerve or vestibular nuclei have been shown to impair the ipsilateral doll's eyes reflex . [7]
What is the arc of the vestibule?
The vestibulo-ocular reflex (VOR) arc consists of a series of brainstem nuclei and the nerves connecting them as well as the vestibular system and the extra-ocular muscles of the eye.
What does it mean when an examiner observes a positive oculocephalic reflex?
The examiner observes a positive oculocephalic reflex when the patient moves their eyes opposite of the rotation of their head, such that their eyes stay looking forward (like a doll’s eyes). The examiner observes a negative oculocephalic reflex when the patient’s eyes stay midline and do not move while the examiner rotates the head. ...
Is the vestibulo-ocular reflex suppressed?
The reflex is suppressed in a conscious adult with normal neurologic function but is active in a comatose patient with gross brainstem function, absent if there is damage to the reflex arc. [6] The reflex arc in the doll's eyes reflex has had extensive research. The vestibulo- ocular reflex (VOR) arc consists of a series ...