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Checking for oculocephalic reflex

PULLEN, RICHARD L. JR., RN, EDD

CLINICAL DO'S & DON'TS
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TEST FOR THE oculocephalic reflex (doll's eye movement) to assess cranial nerves III and VI in a comatose patient. Absence of this reflex indicates severe brain stem injury from the midbrain level to the pons. The presence of this reflex verifies intact brain stem gaze centers and ocular motor nerves in a comatose patient. The reflex is suppressed in an alert patient.

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DO

  • Assess your patient's level of consciousness. Place her in a supine position with the head of her bed elevated at least 30 degrees to minimize intracranial pressure while you assess her eye movements.
  • Hold her eyelids open with the thumb and index finger of one hand so you can watch her eyes.
  • Briskly but gently rotate her head from side to side and assess her eye movements. A normal response is for the eyes to move in the direction opposite the head movement, such as looking left as you turn her head to the right. The oculocephalic reflex is absent if her eyes move in the same direction as her head or stay fixed at midline.
  • Figure

    Figure

  • An alternative way to evaluate your patient's oculocephalic reflex is to gently flex and extend her neck while holding her eyes open. They should move in the opposite direction; for example, she should look up when you move her head downward. The oculocephalic reflex is absent when the eyes move in the same direction as the head.
  • Figure

    Figure

  • Add your findings to other aspects of your patient's neurologic assessment, including the motor and sensory system, other cranial nerves, and spinal reflexes.
  • Document your patient's response.
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DON'T

  • Don't try to elicit the oculocephalic reflex if your patient has a cervical fracture or injury.
  • Don't try to elicit this reflex in a normal, alert person.

Richard L. Pullen, Jr., is a professor of nursing at Amarillo (Tex.) College. Each month, Clinical Do's & Don'ts illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.

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SELECTED REFERENCES

.Dillon PM. Nursing Health Assessment: A Critical Thinking, Case Studies Approach. Philadelphia, Pa., F.A. Davis Co., 2003
    .Hickey JV. The Clinical Practice of Neurological and Neurosurgical Nursing, 5th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2002
      .Sole ML, et al. Introduction to Critical Care Nursing, 4th edition. Philadelphia, Pa., W.B. Saunders Co., 2005
        .Zator-Estes ME. Health Assessment and Physical Examination, 3rd edition. Clifton Park, N.Y., Delmar Publishing Co., 2005
          © 2005 Lippincott Williams & Wilkins, Inc.