What is Dalrymple sign?

Dalrymple sign: Widened palpebral tissue (lid retraction) or lid spasm seen in thyrotoxicosis (Graves-Basedow disease), causing abnormal wideness of the palpebral fissure. As a result of the retraction of the upper eyelid, the white of the sclera is visible at the upper margin of the cornea in direct outward stare. Why lid lag in hyperthyroidism?
Both lid lag and lid retraction are attributed in part to the sympathetic hyperactivity of hyperthyroidism, which causes excess contraction of the Müller muscle (the involuntary lid elevator whose paralysis causes the ptosis of Horner syndrome).

Can hyperthyroidism cause ptosis?

When it is present concomitantly with thyrotoxicosis, it is usually mild, and therefore, can get overlooked when considering differential diagnosis for a patient with hyperthyroid symptoms and muscular weakness. Ptosis is generally not seen in thyroid ophthalmopathy, in contrast to MG. What is Jellinek sign?
Jellinek sign – in Graves disease, a brownish pigmentation of the eyelids, especially the upper ones.

What is von Graefe’s sign?

Medical Definition of von Graefe’s sign : the failure of the upper eyelid to follow promptly and smoothly the downward movement of the eyeball that is seen in Graves’ disease. What does lid lag indicate?

Lid lag is the static situation in which the upper eyelid is higher than normal with the globe in downgaze. It is most often a sign of thyroid eye disease, but may also occur with cicatricial changes to the eyelid or congenital ptosis.

Frequently Asked Questions(FAQ)

What is thyroid Orbitopathy?

Graves’ orbitopathy also referred to as thyroid-associated orbitopathy (TAO) is the extra thyroidal manifestation of Graves’ disease and the most common cause of exophthalmos. It is an immune disorder causing inflammation and expansion of orbital fat and muscle.

How do you remember thyroid eye symptoms?


  1. I: inferior rectus.
  2. M: medial rectus.
  3. S: superior rectus.
  4. L: lateral rectus.
  5. O: obliques muscles (superior oblique and inferior oblique)
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What is a characteristic symptom of Graves hyperthyroidism?

The sudden and drastic increase in thyroid hormones can produce many effects, including fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin and eyes (jaundice), severe low blood pressure, and coma.

What is Thyroid storm?

Thyroid storm is a very rare, but life-threatening condition of the thyroid gland that develops in cases of untreated thyrotoxicosis (hyperthyroidism, or overactive thyroid). The thyroid gland is located in the neck, just above where your collarbones meet in the middle.

Why do you get Exophthalmos in graves?

What are the first signs of thyroid eye disease?

Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen.

What are early warning signs of thyroid problems?

Early signs of thyroid problems include:

  • Gastrointestinal problems. …
  • Mood changes. …
  • Weight changes. …
  • Skin problems. …
  • Sensitivity to temperature changes. …
  • Vision changes (occurs more often with hyperthyroidism) …
  • Hair thinning or hair loss (hyperthyroidism)
  • Memory problems (both hyperthyroidism and hypothyroidism)

Can thyroid problems cause droopy eyelids?

Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice is hoarse, speech is slow, eyelids droop, and the eyes and face become puffy.

What is Mobius sign?

Möbius sign is a clinical sign in which there is an inability to maintain convergence of the eyes. It is found in patients with Graves’ disease. The sign is named after Paul Julius Möbius.

What is thyroid Acropachy?

Thyroid acropachy is a rare complication of autoimmune thyroid disease with characteristic imaging findings. Clinically, it presents as nail clubbing, swelling of digits and toes, almost always in association with thyroid ophthalmopathy and dermopathy.

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What is Epsilon alcoholism?

Epsilon refers to the most advanced stage of alcoholism. It is characterized by periodic alcoholism. You may hear this stage referred to most often as binge drinking.

What is stellwag’s sign?

Stellwag’s sign is a sign of infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy. It is accompanied by Dalrymple’s sign, which is a retraction of the upper eyelids resulting in an apparent widening of the palpebral opening.

What is thyrotoxicosis disease?

Thyrotoxicosis means an excess of thyroid hormone in the body. Having this condition also means that you have a low level of thyroid stimulating hormone, TSH, in your bloodstream, because the pituitary gland senses that you have “enough” thyroid hormone.

What is Muller muscle?

The superior tarsal muscle, known as Muller’s muscle, is a structural muscle which functions to maintain the elevation of the upper eyelid. It receives innervation from the sympathetic nervous system and is unique in that it consists of thin fibers of the smooth muscle.

How do I fix my lid lag?

Several treatment options have been described for correction of eyelid retraction, including Botox and filler injection, and surgeries in the burnt-out stage such as lowering the upper lid by recessing the levator muscle, excision of Müller’s muscle, introducing a spacer, or myotomies.

What Exophthalmos means?

Exophthalmos, also known as proptosis, is the medical term for bulging or protruding eyeballs. It can affect 1 or both eyes and is most often caused by thyroid eye disease.

How is proptosis diagnosed?

An eye doctor can diagnosis proptosis by examining your eye. They can use a special tool called an exophthalmometer to measure your level of eyeball protrusion. Your doctor will also review your medical history and ask you questions about your symptoms.

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What is endocrine Orbitopathy?

Endocrine orbitopathy (EO) is a chronic, multisystem autoimmune disorder caused by lymphocyte infiltration, edema, and proliferation of endo-orbital connective tissue. These conditions involve the extraocular muscles, intraconal and extraconal fat, and, to a lesser extent, the lacrimal gland.

What causes Orbitopathy?

(Graves’ Ophthalmopathy or Graves’ Orbitopathy) Graves’ disease is an autoimmune disease caused by antibodies directed against receptors present in the thyroid cells and also on the surface of the cells behind the eyes. Rarely can also affect the skin, usually the front part of the legs.

Is Pretibial myxedema painful?

PTM is usually asymptomatic, but pruritic or painful lesions have been reported with hyperhidrosis and hypertrichosis. Local application of corticosteroids remains the mainstay of treatment. Compression wraps or stockings that provide 20-40 mm Hg of pressure can be useful as an adjunctive therapy.

Which rectus muscle is involved first?

The inferior rectus is the most frequently involved, followed by the medial, superior, and infrequently the lateral rectus.

What is Pretibial myxedema?

Pretibial myxedema or localized myxedema or thyroid dermopathy is an autoimmune manifestation of Graves’ disease. It also occasionally occurs in Hashimoto’s thyroiditis. Lesions of thyroid dermopathy are usually asymptomatic and have only cosmetic importance.

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