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Dalrymple's sign is a widened palpebral (eyelid) opening, or eyelid spasm, seen in thyrotoxicosis (as seen in Graves' disease, exophthalmic goitre and other hyperthyroid conditions), causing abnormal wideness of the palpebral fissure.
Manual lifting of the eyelid often resolves the problem and the lid is able to stay open. ALO was first clearly described as a distinct entity in 1965 as "a nonparalytic motor abnormality characterized by the patient's difficulty in initiating the act of lid elevation present only momentarily at the start of lid opening."
It is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis. A pseudo Graefe's sign (pseudo lid lag) shows a similar lag, but is due to aberrant regeneration of fibres of the oculomotor nerve (III) into the elevator of the upper lid. [2] It occurs in paramyotonia ...
In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely ...
An epicanthic fold or epicanthus [6] is a skin fold of the upper eyelid that covers the inner corner (medial canthus) of the eye. [3] However, variation occurs in the nature of this feature and the possession of "partial epicanthic folds" or "slight epicanthic folds" is noted in the relevant literature.
The levator palpebrae superioris receives motor innervation from the superior division of the oculomotor nerve. [1] [2] [3] The smooth muscle that originates from its undersurface, called the superior tarsal muscle is innervated by postganglionic sympathetic axons from the superior cervical ganglion.
Blepharospasm usually begins with occasional twitches of both eyelids, which progress over time to forceful and frequent spasms and contractions of the eyelids. In severe episodes, the patient cannot open their eyelids (apraxia), which severely limits their daily activities. Prolonged closure of the eyelids may result in functional blindness. [4]
A positive test is defined by excessive upward excursion followed by downward drift of the upper eyelid immediately after the eye opens, in similar fashion to Cogan's lid twitch sign. The test is negative if the upper eyelid position remains stable when the eye opens. A positive test is consistent with a diagnosis of OMG.