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Hyperthyroidism, as lid lag may be in hyperthyroid patients lacking Graves' disease.
I have lid lag in one eye and the right eye is protruding and very swollen.
Lid lag differs from Von Graefe's sign in that the latter is a dynamic process.
• Eyes prominent or protruding, staring; lid lag present (exophthalmos)
Class 1: Only signs (limited to upper lid retraction and stare, with or without lid lag)
Lid lag is the static situation in which the eyelid is higher than normal with the globe in downgaze.
Griffith's sign is a clinical sign in which there is lid lag of the lower eyelid on moving the eye upwards.
Quite commonly, with thyroid disease, there may be only one eye involved and lid lag and lid retraction are usually signs of thyroid involvement.
These more general symptoms include lid retraction, lid lag, and a delay in the downward excursion of the upper eyelid, during downward gaze.
It is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis.
Also assess the eyes for lid lag (hyperthyroid sign) and the neck for thyroid enlargement and elevated JVP.
What can make things particularly difficult, is that many patients with hyperthyroidism have lid retraction, which leads to stare and lid lag (due to contraction of the levator palpebrae muscles of the eyelids).
A pseudo Graefe's sign (pseudo lid lag) shows a similar lag, but is due to aberrant regeneration of fibres of the oculomotor nerve (III) into the elevator of the upper lid.
Further signs that may be seen on physical examination are most commonly a diffusely enlarged (usually symmetric), nontender thyroid, lid lag, excessive lacrimation due to Graves' ophthalmopathy, arrhythmias of the heart, such as sinus tachycardia, atrial fibrillation, and premature ventricular contractions, and hypertension.