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Researchers find distinction between lid lag, von Graefe's sign
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The terms "lid lag" and "von Graefe's sign" have been used interchangeably in the past as primary criterion for diagnosing Graves' ophthalmopathy. But lid lag appears to be a distinct sign of downgaze-related upper eyelid static position, while von Graefe's sign appears to be a distinct attribute of dynamic movement, according to a retrospective study published in the June issue of Ophthalmology.
"Although von Graefe's sign was commonly exhibited in Graves' patients, the relatively low frequency of lid lag suggests that factors other than restriction/fibrosis are likely responsible for the etiology of eyelid retraction in many cases," the study authors said.
Ramakrishna V. Gaddipati, MD, and Dale R. Meyer, MD, FACS, evaluated the frequency and relationship of eyelid retraction, lid lag, lagophthalmos and von Graefe's sign in 50 Graves' ophthalmopathy patients and compared findings with a group of 50 normal controls. Specifically, the investigators measured eyelid positions while in primary gaze and downgaze in order to record the presence, if at all, of lagophthalmos and von Graefe's sign.
The investigators observed eyelid retraction in 19 patients (38%) in the Graves' group, compared with four patients (8%) in the control group (P = .001).
Lagophthalmos was observed in eight patients (16%) in the Graves' group and in none of the normal controls (P = .010).
The investigators observed von Graefe's sign in 18 patients (36%) in the Graves' group and in none of the normal controls (P < .001).
However, only four Graves' patients (8%) and two normal controls (4%) exhibited lid lag, defined as an increased upper eyelid position while in downgaze, according to the study.