Graefe sign

von Graefe sign (lid lag sign): Failure of the upper lid to follow a downward movement of the eyeball when the patient changes his or her vision from looking up to looking down. Typically associated with hyperthyroidism and exophthalmos

The sign describes the appearance of white sclera between the margin of the upper eyelid and corneal limbus as the patient looks downward.

History

1864 – Friedrich Wilhelm Ernst Albrecht von Graefe first described the finding now given his name at the Berlin Medical Society on March 9, 1864.

Von Graefe noted that in exophthalmos, the upper eyelid fails to follow the downward movement of the eye. He believed it was present even in very slight exophthalmos, was most likely due to involvement of Müller’s muscle, and was pathognomonic of Basedow disease.

‘When normal individuals elevate or lower their glance, the upper eyelid makes a corresponding movement. In patients suffering from Basedow disease, this is entirely abolished or reduced to the minimum. That is, as the cornea looks down, the upper eyelid does not follow.’ [1864;16:158-160]

1932 – Ruedemann applied the more commonly used term ‘lid lag‘ in his chapter on ‘Ocular changes associated with hyperthyroidism‘

Alternative names

• Lid Lag
• Graefe’s Lid Sign
• von-Graefe-Zeichen

Associated Persons

• Robert James Graves (1796–1853) [Graves-Basedow disease]
• John Dalrymple (1803–1852) [Dalrymple sign]
• Karl Stellwag von Carion (1823–1904) [Stellwag sign]
• Albrecht von Graefe (1828-1870)
• Paul Julius Möbius (1853-1907) [Möbius sign]
• Alix Joffroy (1844-1908) – [Joffroy sign]

References

• von Graefe A. Über Basedow’sche Krankheit. Deutsche Klinik, 1864;16:158-160 [Graefe sign]
• Power H, Sharkey. Graefe’s Lid Sign. Br Med J 1890;2:959
• Ruedemann AD. Ocular changes associated with hyperthyroidism. In: Diagnosis and Treatment of Diseases of the Thyroid Gland [Crile GW]. Saunders. 1932:196–208.
• Cadogan M. Eponymythology: Diffuse Toxic Goitre.
• Cadogan M. Eponymythology: Graves Orbitopathy.