Dolls Eye Maneuver, Dolls Head Maneuver

Doll’s Eye Maneuver, Doll’s Head Maneuver

This test of the vestibulo-ocular reflex (VOR) is demonstrated by rotating the patient’s head and looking for a conjugate eye movement in the opposite direction. Although this can be done in a conscious patient focusing on a visual target, smooth pursuit eye movements may compensate for head turning; hence the head impulse test (q.v.) may be required. The maneuver is easier to do in the unconscious patient, when testing for the integrity of brainstem reflexes.

A slow (0.5-1.0 Hz) doll’s head maneuver may be used in conscious patients to assess vestibulo-ocular reflexes. While directly observing the eyes, "catch up" saccades may be seen in the absence of VOR. Measuring visual acuity (dynamic visual acuity, or illegible E test) two to three lines may be dropped on visual acuity with head movement compared to visual acuity with the head still if VOR is impaired. On ophthalmoscopy, the disc moves with the head if VOR is lost.

Cross References

Bell’s phenomenon, Bell’s sign; Caloric testing; Coma; Head impulse Test; Oculocephalic response; Supranuclear gaze palsy; Vestibulo-ocular reflexes