If a patient exhibits lid lag during downgaze, which sign is most likely?

If a patient exhibits lid lag during downgaze, which sign is most likely?

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

Answer: (C)

Von Graefe's sign is lid lag of the upper eyelid during downgaze. In Graves' orbitopathy, inflammation and fibrosis affect the extraocular muscles and the levator palpebrae superioris, so the lid cannot keep pace with the globe as the eye moves downward. The result is the eyelid appearing to lag behind the eye when looking down. This helps distinguish lid movement abnormalities in Graves' disease from other lid signs, such as lid retraction at rest or infrequent blinking.

Von Graefe's sign is lid lag of the upper eyelid during downgaze. In Graves' orbitopathy, inflammation and fibrosis affect the extraocular muscles and the levator palpebrae superioris, so the lid cannot keep pace with the globe as the eye moves downward. The result is the eyelid appearing to lag behind the eye when looking down. This helps distinguish lid movement abnormalities in Graves' disease from other lid signs, such as lid retraction at rest or infrequent blinking.