Paul Julius Moebius

Paul Julius Möbius (1853 – 1907)

Paul Julius Möbius (1853 – 1907) was a German neurologist.

Möbius specialised in neuroanatomy and neurological disorders but published on a wide variety of topics including thyroid dysfunction, gender determination and the inheritance of mental attributes

Through his studies of dysfunction and paralysis of the eye muscles, and in particular Morbus Basedow (Graves disease), he established increased activity of the thyroid gland as the cause of the disease and weakness of convergence, the so-called Möbius sign, as a diagnostic test


Biography
  • Born January 24, 1853 Leipzig
  • 1883 – Habilitated in Neurology
  • Died January 8, 1907 Leipzig

Medical Eponyms
Möbius disease (1884)

Paralysis of the oculomotor nerve usually associated with migrainous headache and facial palsy lasting 3-5 days. Caused by compression of the third cranial nerve by the posterior cerebral and superior cerebral arteries. Most commonly occurs in young adults. [ophthalmoplegic migraine]

Möbius syndrome (1888)

Rare congenital condition characterised by the absence or underdevelopment of the abducens (VI) and facial nerve (VII) nuclei. [congenital facial diplegia syndrome]


Möbius sign (1894)

Weakness of eye convergence in hyperthyroidism; a situation when one eye converges and the other diverges when looking at the tip of one’s nose.

In 1883, Möbius first drew attention to the finding of ‘incomplete convergencein cases of Basedow disease. He went on to discuss the sign in more detail in 1886on the basis of the examination of 10 patients, 8 of whom demonstrated a varying severity of the finding

In 1891, he reviewed the clinical signs, symptoms and related pathology since the original description of diffuse toxic goitre and added further to his original description of the insufficiency of convergence

Alle sonstigen Bewegungen der Augäpfel sind frei, soll aber der Kranke auf einen nahen Gegenstand (die eigene Nasenspitze, den vor das Gesicht gehaltenen Finger) sehen, so blicken die Augen nach rechts oder nach links und nur ein Auge sieht den Gegenstand. Am deutlichsten ist es, wenn man den Kranken erst nach der Stubendecke und dann auf die eigene Nase sehen lässt. Nähert man den Finger allmählich, so convergiren zunächst die Augen, bei einem Nahepunkte aber, dessen Abstand vom Auge bei verschiedenen Kranken und bei demselben Kranken zu verschiedenen Zeiten verschieden ist, hört die Convergenz auf und die parallel gewordenen Augenaxen wenden sich seitlich, so dass nur das nach innen gedrehte Auge noch fixirt. Die Kranken wissen von dem Vorgange nichts, haben keine Doppelbilder, klagen nur über ein Gefühl von Spannung, so lange die Augen convergiren. Die Insufficienz der Convergenz steht nicht in einem geraden Verhältnisse zum Exophthalmus. Sie kommt auch ausserhalb der Basedow’schen Krankheit vor.

Charcot u. A. haben das von mir beschriebene Zeichen auch beobachtet, bezeichnen es aber als selten. Nach meinen Erfahrungen in den letzten Jahren ist es allerdings seltener, als ich anfangs glaubte, doch scheint es mir in der Mehrzahl der Fälle vorhanden zu sein, wenn es auch nicht immer sehr ausgeprägt ist.

Um eine wirkliche Lähmung handelt es sich nicht. Der Exophthalmus allein kann auch nicht die Ursache sein. Ich meine, der Exophthalmus erschwert überhaupt die Augenbewegungen. Dieselben sind aber von vornherein bei der Basedow’schen Krankheit kraftlos. Die Schwäche macht sich am ehesten bei der Convergenz, als der am meisten anstrengenden Augenbewegung, geltend

Möbius 1891; 1(5-6): 402

All other movements of the eyeballs are normal, but if the patient is to look at a nearby object (such as the tip of his nose or a finger held in front of his face), the eyes look to the right or to the left, and only one eye sees the object. This is seen most prominently when the patient is asked to first look at the ceiling and then at his own nose.

On looking at a finger moved toward the patients nose, the eyes converge to a point that varies between patients and at different times for the same patient. After this point, only one of the eyes fixates onto the object, whilst the other abducts to align in parallel with the adducted eye’s axis.

Whilst the eyes converge, the patient complains of eye strain. They are not however aware of the abnormal movements, nor do they suffer with double vision. The inability to converge is not directly related to the degree of exophthalmos. It also occurs without Basedow disease.

Charcot et al, corroborate my findings but have described them as ‘rare’ occurrences. In my experience over the past years, its incidence is less frequent than I had originally thought, however it does occur in most cases of Basedow’s disease, if only to a mild degree.

The insufficiency is not a real paralysis, neither is it caused by the exophthalmos. Exophthalmos does limit eye movements. Eye movements are also weakened at the onset of Basedow disease. The weakness is seen at the earliest during convergence, the most strenuous of the eye movements.

Möbius 1891; 1(5-6): 402


Controversies
  • Möbius – frequently anglicized to Moebius

Major Publications

References

Biography

Eponymous terms


eponymictionary CTA

eponym

the person behind the name

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books |

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