Which sign is used to describe eyelid lag during downgaze in thyroid eye disease?

Which sign is used to describe eyelid lag during downgaze in thyroid eye disease?

• A. Kocher's sign
• B. Von Graefe's sign
• C. Dalrymple's sign
• D. Stellwag's sign

Answer: (B)

Eyelid movement abnormalities in thyroid eye disease include a specific lag of the upper lid when the eyes look downward. This downward-gaze lid lag is called Von Graefe's sign. It happens because the muscles that elevate the lid and the deep orbital tissues are affected, so the upper eyelid cannot keep pace with the eye as it moves down, leaving more sclera exposed above the iris. To observe it, have the patient look down from primary position and watch for a delay in the eyelid’s movement relative to the globe. This distinguishes it from other eyelid signs: lid retraction seen in primary gaze (Dalrymple's sign) and infrequent blinking (Stellwag's sign) describe different aspects of Graves’ ophthalmopathy and do not denote lid lag on downgaze.

Eyelid movement abnormalities in thyroid eye disease include a specific lag of the upper lid when the eyes look downward. This downward-gaze lid lag is called Von Graefe's sign. It happens because the muscles that elevate the lid and the deep orbital tissues are affected, so the upper eyelid cannot keep pace with the eye as it moves down, leaving more sclera exposed above the iris. To observe it, have the patient look down from primary position and watch for a delay in the eyelid’s movement relative to the globe. This distinguishes it from other eyelid signs: lid retraction seen in primary gaze (Dalrymple's sign) and infrequent blinking (Stellwag's sign) describe different aspects of Graves’ ophthalmopathy and do not denote lid lag on downgaze.