Graefe-sign

In 1864, Albrecht von Graefe (1828 - 1870) was the first to describe the receding of the upper eyelid when the gaze is lowered downward as part of an endocrine orbitopathy (Rohrbach 2020).

A Graefe's sign is the receding of the upper eyelid when the gaze is lowered (Herold 2022), so that the upper limbus appears exposed (Dennis 2019).

"Eyelid lag" is when the upper eyelid stays back when looking down. This can occur:

- in the context of an endocrine orbitopathy and is then called a "Graefe's sign".

- as a side effect of ptosis surgery

- in congenital ptosis (Grajewski 2022)

- Performance of the examination:

One has the patient fixate an index finger while performing a circular movement of the index finger from top to bottom (Holldack 2005).

The specificity of the Graefe's sign is 99% and the sensitivity is 19%. The positive likelihood ratio is 31.5% for Graves' disease (Dennis 2019).

Graefe's sign, together with Stellwag 's sign (infrequent blinking [Mattle 2008]), Dalrymple 's sign (retraction of the upper eyelid with scleral crescent [Kampig 2014]), and Möbius ' sign (convergence disorder [Mattle 2008]), are among the 4 classic ocular signs of endocrine orbitopathy (Kampig 2014).

In the context of endocrine orbitopathy, Graefe's sign occurs as an early and important sign (Reiß 2009).

The mechanism of the Graefe's sign has not yet been conclusively clarified. A combination of several factors is suspected (Dennis 2019).

- Pseudo Graefe's sign (Kampig 2014)

Here, a unilateral eyelid elevation occurs when looking downward. The cause is synkinesia of the eyelid after lesion of the oculomotor nerve (Hufschmidt 2017).

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