Failure of the upper lid to follow a downward movement of the eyeball when the patient changes his or her vision from looking up to looking down. The lid moves tardily and jerkily. Seen in Basedow’s disease (exophthalmic goiter/hyperthyroidism). Due to aberrant regeneration of the 3rd nerve after injury.
This symptom depends on the degree of exophthalmus and may occur early in the progress of the disease. Albrecht von Graefe considered it pathognomonic to tyreotoxicosis, but it may also occur in other diseased conditions, like ulcer. In Basedow's disease it occurs in ca 50 of all cases.
We thank Patrick Jucker-Kupper, Switzerland, for information submitted.
- A. F. W. E. von Graefe:
Über Basedow’sche Krankheit.
Deutsche Klinik, 1864, 16: 158-159.