Typically the doll's eyes reflex is elicited by turning the head of the unconscious patient while observing the eyes. The eyes will normally move as if the patient is fixating on a stationary object. If there is a negative doll's eyes reflex then the eyes remain stationary with respect to the head.
The doll's eyes reflex may be tested in the conscious subject when determining the aetiology of a gaze palsy; whether the lesion is "nuclear" or "supranuclear". If there is damage to brainstem gaze centres then voluntary and reflex eye movements are reduced. If there is damage to the cortical gaze centre then voluntary movement is lost but the doll's eyes reflex is retained.
The reflex may be suppressed in the normal conscious subject.
If the doll's eye reflex is absent then there is a lesion in the following pathway:
- the labyrinth and vestibular nerve
- the neck proprioceptors
- cranial nerves 3 and 6
- the external ocular muscles
The normal doll's eyes reflex is NOT dependent on visual fixation of a stationary object, indeed it is present in comatose patients who are blind or in the dark.