Which sign describes lid lag during downgaze?

Which sign describes lid lag during downgaze?

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

Answer: (A)

Lid lag on downgaze is described by Von Graefe's sign. In Graves' ophthalmopathy, the upper lid tends to retract due to overactivity of the levator/Müller complex from sympathetic stimulation. When the patient looks downward, the globe moves down and the lid does not keep up, so the lid position lags behind the moving eye and more sclera can be seen above the iris. This specific lag during downgaze distinguishes Von Graefe's sign from other lid signs in Graves' disease, such as Stellwag's sign (infrequent blinking) or Dalrymple's sign (lid retraction with scleral show in primary gaze).

Lid lag on downgaze is described by Von Graefe's sign. In Graves' ophthalmopathy, the upper lid tends to retract due to overactivity of the levator/Müller complex from sympathetic stimulation. When the patient looks downward, the globe moves down and the lid does not keep up, so the lid position lags behind the moving eye and more sclera can be seen above the iris. This specific lag during downgaze distinguishes Von Graefe's sign from other lid signs in Graves' disease, such as Stellwag's sign (infrequent blinking) or Dalrymple's sign (lid retraction with scleral show in primary gaze).