This reflex helps assess brainstem function in the comatose patient. Holding the upper eyelids open so that you can see the eyes, turn the head quickly, first to one side and then to the other (Fig. 1). Make sure the patient has no neck injury before performing this test.

FIGURE 1. Test the oculocephalic reflex.
In a comatose patient with an intact brainstem, as the head is turned in one direction, the eyes move toward the opposite side (the doll's eye movements). In Figure 2, for example, the patient's head has been turned to the right; her eyes have moved to the left. Her eyes still seem to gaze at the camera. The doll's eye movements are intact.

FIGURE 2. Oculocephalic reflex intact.
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