Lid lag or lid retraction is most consistent with which thyroid state?

• A. Hyperthyroidism
• B. Hypothyroidism
• C. Diabetes
• D. Addison's disease

Answer: (A)

Lid lag or lid retraction is a sign tied closely to thyrotoxic states, especially Graves’ disease. When thyroid hormone is in excess, sympathetic activity rises and orbital tissues can become involved, leading to overaction of the muscles that elevate the eyelid (the levator and Müller's muscle). As a person looks downward, the globe moves more quickly than the eyelid, so the upper lid lags behind and may appear to retract or ride higher, sometimes revealing sclera above the iris. This characteristic finding is not typical of hypothyroidism, diabetes, or Addison’s disease, which do not produce lid lag in the same way.