Oculocephalic and caloric response

Oculocephalic (doll's eyes) response: This test should not be performed if a cervical spine injury is suspected. Observe the motion of the eyes while passively moving the head. In a comatose patient, conjugate movement of the eyes in the direction opposite to the head movement is expected. An absent or asymmetric response in an unconscious patient implies brainstem dysfunction.
Caloric response: After visually checking that the tympanic membrane is intact, ice cold water is used to irrigate the ear canal and should produce a slow conjugate deviation toward the irrigated side. An absent or asymmetric response indicates brainstem dysfunction. Intact eye deviation with nystagmus suggests that the patient may not be in coma.

Adapted from: Bateman DE. Neurologic assessment of coma. J Neurol Neurosurg Psychiatry 2001; 71 Suppl 1:13.

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