Eyelid Retraction, Lid Lag, Lagophthalmos, and von Graefe's Sign: Quantifying the Eyelid Features of Graves' Ophthalmopathy
Received 19 February 2007; received in revised form 13 July 2007; accepted 24 July 2007. published online 27 September 2007.
Purpose
To report the frequency and relationship of eyelid retraction, lid lag, lagophthalmos, and von Graefe's sign in a group of patients with Graves' ophthalmopathy and compare these findings to those in a group of normal individuals.
Design
Retrospective comparative cohort study.
Participants
Fifty consecutive Graves' ophthalmopathy patients were compared to a control group of 50 normal individuals.
Methods
Measurements were made of eyelid position in primary gaze and downgaze to assess eyelid retraction and lid lag, and the presence of lagophthalmos and von Graefe's sign was noted when present.
Main Outcome Measures
Eyelid position in primary gaze and downgaze and presence of lagophthalmos and von Graefe's sign.
Results
In the Graves' group, eyelid retraction (38%), von Graefe's sign (36%) and lagophthalmos (16%) were observed at a significantly greater frequency (P<0.01) than in normals, whereas true eyelid lag was observed in only 8% (P = 0.67).
Conclusions
The terms lid lag and von Graefe's sign have been used interchangeably in the past; however, they are distinct signs of downgaze-related upper eyelid static position and dynamic movement, respectively. Although von Graefe's sign was commonly exibited 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.
Available online: September 27, 2007.
Division of Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, New York.
Correspondence to Dale R. Meyer, MD, Ophthalmic Plastic Surgery, Lions Eye Institute, 1220 New Scotland Road, Suite 302, Slingerlands, NY 12159.
Manuscript no. 2007-238.
The authors have no proprietary interest in any aspect of the work.
ABSTRACT