The trio of signs Von Graefe's, Kocher's, and Dalrymple's are associated with which condition?

• A. Parkinson's disease
• B. Thyroid eye disease
• C. Glaucoma
• D. Conjunctivitis

Answer: (B)

These signs point to Graves' ophthalmopathy, also called thyroid eye disease. In this autoimmune condition, tissue in the orbit, especially the extraocular muscles and connective tissues, becomes inflamed and can fibrose. This pull on the eyelids causes upper lid retraction, so the eyelid sits higher than normal and can expose more sclera. The lid retraction appears most clearly as scleral show when the patient looks straight ahead (Dalrymple’s sign). It also shows up as a lag of the upper lid during certain eye movements, such as when the eye looks downward (Von Graefe’s sign). The combination of these lid movement abnormalities is characteristic of thyroid eye disease and helps distinguish it from conditions like Parkinson’s disease, glaucoma, or conjunctivitis.