In thyroid eye disease, upper eyelid lag during downgaze is known as which sign?

• A. Kocher's sign
• B. Von Graefe's sign
• C. Stellwag's sign
• D. Dalrymple's sign

Answer: (B)

This question targets how eyelid movement changes with gaze shifts in thyroid eye disease. When the eye looks downward, the upper eyelid should move smoothly with the globe. In thyroid eye disease, fibrosis and dysfunction of the eyelid elevating muscles slow the lid, so the upper lid lags behind the downward movement of the eye. This lag during downgaze is the sign known as Von Graefe's sign.

Clinically, you may see the lid not descend as quickly as the eye, sometimes with brief scleral exposure as the eye moves down. This helps distinguish dynamic lid movement abnormalities from other lid findings: Dalrymple's sign is lid retraction in primary gaze, Stellwag's sign is infrequent blinking, and Kocher's sign refers to a different lid finding not describing this specific lag.