Doll's eyes reflex...

Specialties Neurological

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Hi...I'm hoping someone can explain the oculocephalic response to me. I'm about to finish nursing school, and we do clinicals at a hospital that "doesn't do" neuro care (i.e. they transport neuro patients to a bigger hospital). I'm really interested in neuro, and am bummed about this. Anyhow. My book (Black/Hawks Medical Surgical Nursing) says

"The OCR/doll's eye reflex is movement of the eyes in the direction opposite that in which the head is moved. For example, the reflex is present if the eyes move to the right when the head is rotated to the left, and vice versa. The absence of the doll's eye reflex indicates that brain stem function is preserved. The reflex is present in patients with brain stem problems. In the patient without Meniere's disease or evidence of neuromuscular drugs, however, absence of the oculocephalic response supports the diagnosis of brain death."

Except I've read on this site, and I'm fairly certain in other places, that you WANT the doll's eye reflex to be intact. So I'm confused. Can anyone explain this test to me, and also explain whether it being "present" supports brain death, or supports intact brain stem activity?

Thanks!

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Specializes in Infectious Disease, Neuro, Research.
"The OCR/doll's eye reflex is movement of the eyes in the direction opposite that in which the head is moved. For example, the reflex is present if the eyes move to the right when the head is rotated to the left, and vice versa. The absence of the doll's eye reflex indicates that brain stem function is preserved.

There is absence of the fixed & dilated gaze, indicating cessation of brainstem function, i.e., at least on a primary level, "somebody's home". You have some unclear statements in the text. In a conscious, but aphasic, patient, DE may be consciously maintained. This can be further evaluated by watching their ability (or inability) to track.

The reflex is present in patients with brain stem problems. In the patient without Meniere's disease or evidence of neuromuscular drugs, however, absence of the oculocephalic response supports the diagnosis of brain death."

The second part of the unclear statement- in this instance, the pt's gaze is "fixed" because they have localized their gaze, but are not doing so in conscious mechanism.

Basically, you are testing for attention and tracking- if the patient appears able to do both/either, the brainstem (at least) is functional.

XB9S, neither of those mention what I have heard to be the most obvious sign of brain death- election to Parliament.:D

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Specializes in Advanced Practice, surgery.

XB9S, neither of those mention what I have heard to be the most obvious sign of brain death- election to Parliament.:D

ROFL,

coffee keyboard incident :D :D :D

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