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Oculocephalic Reflex or the Doll’s Eyes Phenomenon

Medically reviewed by Sandeep Dhanyamraju
Medically reviewed by Sandeep Dhanyamraju

Sometimes a person has a reflex deviation of the apples of the eye to one side. This anomaly, which occurs when the patient tries to turn their head vertically or horizontally, is called an oculocephalic reflex.

Oculocephalic reflex is caused by quickly turning and briefly holding the patient’s head to the right, then to the left, and unbending and bending the neck. In this case, the eyes deviate in the opposite direction (for example, when turning the head to the left, the eyes deviate to the right). This reflex can be investigated only in the absence of an injury to the cervical spine. In patients with severe traumatic brain injury, the head can only be turned in the horizontal plane.

The normal oculocephalic reflex reflects the safety of the labyrinths, neck proprioceptors, vestibular nuclei, and their connections with the nuclei of the oculomotor nerves, the medial longitudinal fascicle. If, when turning the head, the eyeballs remain in the same position, then the damage is localized at the level of the nuclei of the abducens nerves, vestibular nuclei, and their connections. If, when turning the head, abduction of the eye is preserved, but adduction is disturbed, then the lesion is located at the level of the medial longitudinal bundle, which carries out connections between the nuclei of the abducens oculomotor nerves. Asymmetric uncomfortable eye deviation and uncomfortable eye movements in assessing the oculocephalic reflex indicate structural damage to the brain stem and are often called doll’s eyes.

This phenomenon is observed in newborns. In most cases, a strange symptom manifests itself in those children who were born prematurely. Also, this phenomenon is diagnosed with metabolic disorders and all kinds of intoxications.

Physiological Functions of the Eccentric Gaze Fixation

The value lies in that it allows you to fix the gaze on a stationary object and provide a projection of the gaze fixation point on the retina in the zone of best vision during head movements or acceleration. 

  • In a healthy, awake person, the oculocephalic reflex can be arbitrarily suppressed due to the influences of the cerebral cortex on the stem structures. 
  • If this reflex is disturbed, patients cannot read since they cannot stabilize their gaze during a small physiological tremor of the head.
  • The activity of stem structures is associated not only with the mechanisms of the gaze, but also the mechanisms of its stable fixation, i.e., stable gaze retention due to active suppression of eyeball movements. It is essential to ensure the stability of the gaze in an eccentric position of the eyes
  • The mechanisms of keeping the horizontal gaze are realized with the participation of the vestibular nuclei, vestibulocerebellum, and the nucleus praepositus Hypo-glossy, which lies in the bottom of the fourth ventricle between the nucleus of the hypoglossal nerve, located more caudally, and the nucleus of the abducens nerve, located rostral. 
  • The mechanisms for maintaining the vertical gaze are realized with the participation of the Cajal interstitial nucleus.

The Mechanism of Occurrence of the Oculocephalic Reflex   

The emergence of this reflex is explained as follows. 

  • Normally, rotation of the head leads to displacement of the endolymph in the semicircular canals in the direction opposite to this rotation. In this case, in one labyrinth, an endolymph current arises towards the ampulla of the horizontal semicircular canal and in the other labyrinth in the direction from the ampulla of the canal. 
  • There is an increase in irritation of the receptors of one and a decrease in irritation of the receptors of the opposite vestibular apparatus, i.e., imbalance of impulses coming to the vestibular nuclei. 
  • When the vestibular nuclei are irritated on one side, the information is immediately transmitted to the contralateral nucleus of the abducens nerve in the Varolievy pons, from where impulses through the medial longitudinal bundle reach the nucleus of the oculomotor nerve in the midbrain on the side of the irritated vestibular apparatus. This provides asynchronous contraction of the lateral rectus muscle of the eye opposite to the irritated labyrinth and the medial rectus muscle of the eye of the same name, which ultimately leads to a slow, friendly deviation of the eyes in the direction opposite to the direction of head rotation for oculocephalic reflex.

In other words, the rotational movement of the head to the left leads to an increase in the frequency of discharges in the left vestibular nerve, increased excitation of the left vestibular nucleus, excitation of neurons in the nucleus of the right abducens nerve, and reflex abduction of the right eyeball due to contraction of the lateral rectus muscle of the right eye. Simultaneous turn of the left eye to the right occurs due to the transmission of excitation through the medial longitudinal bundle to the motor nucleus of the left oculomotor nerve and contraction of the medial rectus muscle of the left eye.

Diagnosis of Oculocephalic Reflex or the Doll’s Eyes

Eccentric gaze fixation disorders can manifest as nystagmus and saccades/oscillations. A significant difference concerns the initial movement that takes the visual line away from the object in question. Such an initial movement that takes the eye away from the target, with nystagmus, is a slow drift, and with saccadic oscillation, a rapid movement of the eyeball.

Clinical diagnosis of disorders of the eye movement system requires a series of tests while finding out the cause of such disorders is a comprehensive clinical and neurological study.

Dr. Cantelli first described the oculocephalic reflex. Medical specialists are deciphering the essence of the oculocephalic reflex thanks to the research already available. Everything depends on the state of the investigated person. The following is taken into account:

  • The patient is conscious.
  • The patient is in a coma.
  • Development of a coma against the background of 1 lesion of the cortex.
  • Violation of the cortex against the background of 2-fold deformation of the pons.

The procedure should be carried out quickly. In no case should such manipulations be carried out if there is a suspicion of damage to the cervical spine.

  • 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.

Oculocephalic Reflex in People in Coma

When a person is in a severe coma, the doctor should put them on their back. Then the examiner performs the following manipulations:

  • carries out passive turns of the subject’s head in the vertical direction;
  • carries out passive turns of the subject’s head in the horizontal direction.

If the patient is in a coma and the presence of an anomaly is not observed, then the doctor diagnoses inorganic damage to the brain stem structures. It is important to consider that a negative oculocephalic reflex is a norm when awake because an effort of will can suppress it. If a person is in a coma, then the functions of the brain trunk are preserved. At the same time, as a result of turning the head to one side (this phenomenon is called mechanical irritation), the eyeballs (combined) move in a completely different direction.

The eyes of a patient who is currently in a coma cannot be fixed on the midline. The opposite is observed if the main function of the brain stem is impaired.

When a fatal outcome occurs, it is easy to draw a parallel with a trunk lesion. In this case, the eyes become lifeless, as if drawn and are fixed strictly along the middle line.

If the person under study is not in a coma, then they have a high degree of activity in the cerebral cortex of the GM. This activity helps to suppress and arrest the doll’s eyes reflex. At the same time, the person’s eyes look straight ahead.

If the patient is in a severe coma and the presence of an anomaly is not observed, then the doctor diagnoses inorganic damage to the brain stem structures. It is important to consider that a negative oculocephalic reflex is a norm when awake because an effort of will can suppress it.

Oculocephalic Reflex

Treatment of Oculocephalic Reflex

Eccentric gaze fixation appears in adults when the correct diagnosis was not made in childhood, or the necessary treatment was lacking. Therapy begins with identifying the cause of the change in the functioning of the eye system.

Adults require an increased course of treatment, as the struggle for a healthy eye is often difficult. The therapy is carried out using special devices that activate the functions of the eye.

  • Video-computer vision correction shows excellent results.
  • A course of physiotherapy equipment is prescribed by a doctor to treat eccentric gaze fixation in children and adults, based on medical indicators.
  • Treatment by occlusion is the most ancient but effective method. The occluder can be in the form of a bandage for small children, a shutter in glasses, a sticker on the glass. The neglect of the case regulates the duration of wearing the occluder. It can be periodic or constant and is corrected as visual acuity indicators improve.

If you have oculocephalic reflex or symptoms that may be causing it, you should see your doctor right away. The doctor will be able to correctly diagnose and prescribe treatment.

FAQs

  • What disease can cause a reflex deviation of the apples of the eye to one side?

This anomaly, which occurs when the patient tries to turn their head vertically or horizontally, is called an oculocephalic reflex.

  • What do positive doll’s eyes mean?

If the reflex in the eyes is not impaired, they demonstrate a conjugate movement in the direction opposite to the movement of the head; however, if the reflex is impaired (negative doll head maneuver), the eyes remain stationary.

  • How does the vestibular-ocular reflex work?

This reflex uses information from the inner ear to create eye movements that help stabilize the gaze. This reflex helps to focus when walking.

  • What is the normal oculocephalic reflex?

Most often it is a reflex that helps the eye movement while the head is moving in the opposite direction. It is possible to establish the absence of this reflex when the eyes move in the same direction as the head.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
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Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
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Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
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Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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