Positive Doll's Eyes???

live4today, RN · Mar 19, 2002

Originally posted by Healingtouch
Can someone please explain to me what a positive doll's eyes sign means and how to assess? Thank you so much :)

Hi Healingtouch, :)

According to my ICU book, a positive doll's eye sign is when the eyes deviate away from the direction of rotation (if the head is rotated to the right, the eyes will deviate to the left). When the brainstem is damaged or when the patient is awake, there is no eye deviation (the eyes will follow the direction of head rotation). The popular term "doll's eyes" was originally used to describe the reflex opening of the eyelids that is occasionally observed when the neck is flexed. However, this term is now used to indicate a positive oculocephalic reflex (brainstem intact).

Newborn babys have what is termed a doll's eye reflex (a normal response in newborns to keep the eyes stationary as the head is turned to the right or left). This reflex disappears as ocular fixation develops.

P_RN, ADN, RN · Mar 19, 2002

http://uscneurosurgery.com/library/trauma/evaluation/5%20pupillaryresponse.htm

try this site.

VickyRN, MSN, DNP, RN · Mar 20, 2002

Thank you so much for the info. Neuro has been one of my weak points; need to become more proficient as we occasionally see neuro overflow in the unit.

CEN35 · Mar 20, 2002

positive dolls eyes is a good thing! negative dolls eyes.........and the first thing i think of is organ donation! sad but true.

me :)

CEN35 · Mar 20, 2002

actually............there is another test also, for neuro/brainstem function, which i cannot remember the name.

you take a 30cc syringe, and an iv catheter. you fill a cup with ice water, and draw it up. then you squirt it into the ear canal. i can't remember what it is called, or what response to look for though? any neuro people out there?

me :)

live4today, RN · Mar 20, 2002

originally posted by cen35
actually............there is another test also, for neuro/brainstem function, which i cannot remember the name.

you take a 30cc syringe, and an iv catheter. you fill a cup with ice water, and draw it up. then you squirt it into the ear canal. i can't remember what it is called, or what response to look for though? any neuro people out there?

me :)

cen, the test you are referring to is used when checking for the oculovestibular reflex (cold calorics).

that particular reflex is elicited by injecting 30 ml of iced saline in the external auditory canal using a syringe and a short 2 inch catheter. when the brainstem is intact, the response involves conjugate eye deviation towards the irrigated ear. if the hemispheres are intact, there will also be a few minutes of nystagmus with the rapid component away from the irrigated ear. this nystagmus is not expected when the cerebral hemispheres are impaired. [compliments of my icu book, titled: the icu book, written by paul l. marino]

i worked neuro and sicu at one time, out of many other units i've cross-trained on, and neuro use to be one of my favorites until i cross-trained to pediatrics. love those little rugrats now!

CEN35 · Mar 20, 2002

thanks for the response on that one!!! i remember it now that you refreshed it for me. i just haven't used it in a long time!

me :)

live4today, RN · Mar 20, 2002

NO PROBLEM, CEN35! :)