Gräfe

Gräfe's Sign is a clinical sign observed in patients with thyroid eye disease (TED) or Graves' ophthalmopathy, which are conditions often associated with Graves' disease, an autoimmune disorder affecting the thyroid gland. This sign is named after the German ophthalmologist Albrecht von Graefe who first described it in the 19th century. Gräfe's Sign is characterized by a delay in the movement of the upper eyelid when a person moves their gaze downward. This lag is due to the dysfunction of the levator palpebrae superioris muscle, which is responsible for lifting the upper eyelid. In the context of thyroid eye disease, the muscle becomes inflamed or fibrotic, leading to its impaired function.

Clinical Presentation

Patients with Gräfe's Sign will exhibit a noticeable lag or delay of the upper eyelid as it fails to follow the downward movement of the eye promptly. This can be observed by asking the patient to slowly shift their gaze from an upward position to a downward position. The healthcare provider looks for a white rim of sclera that becomes visible above the iris as the eye moves downwards, indicating that the eyelid is not keeping pace with the eyeball.

Diagnosis

The diagnosis of Gräfe's Sign is primarily clinical, based on the observation of the sign during a physical examination. However, diagnosing the underlying cause, such as Graves' disease or thyroid eye disease, may require additional tests, including blood tests to measure levels of thyroid hormones and thyroid-stimulating antibodies, as well as imaging studies like CT scan or MRI to assess the condition of the eye muscles.

Treatment

Treatment of Gräfe's Sign involves addressing the underlying thyroid disorder and managing the symptoms of thyroid eye disease. This may include:

• Antithyroid drugs to control hyperthyroidism in Graves' disease.
• Corticosteroids to reduce inflammation in the eye muscles.
• Selenium supplements, which have been shown to benefit mild thyroid eye disease.
• Eyelid surgery or strabismus surgery in severe cases to correct the position of the eyelids or align the eyes, respectively.

Prognosis

The prognosis for patients with Gräfe's Sign depends on the severity of the underlying thyroid eye disease and the effectiveness of the treatment. Early diagnosis and management of the thyroid condition can improve outcomes and reduce the severity of eye symptoms.

See Also

• Exophthalmos
• Dalrymple's sign
• Möbius sign

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