Lid lag, also known as the von Graefe sign, is most commonly treated by addressing the underlying reason why the condition developed. Medication, radioactive iodine therapy, or surgery can also be used to treat the hyperfunctioning thyroid gland that typically causes the eye abnormality. Patients with lid lag benefit from supportive measures to decrease the complications that might result from this condition, and can use eye drops or nighttime eyelid taping to alleviate eye dryness. Other approaches towards the treatment of this condition can include giving immunosuppressive medications, administering radiotherapy to the eyes, or operating on the eyes.
The most fundamental treatment for lid lag is to deal with any underlying thyroid disease that might be present. Often one of the first steps used to treat hyperthyroidism is to give medications to decrease the production of excess thyroid hormone, and to also give drugs that decrease the effect the thyroid hormone can have on the body. Beta blockers, a class of medication including the drug propranolol, are given because they block some of the effects that thyroid hormone has on the body. Other medications in the thionamide class of drugs work to decrease the formation of thyroid hormone by blocking a specific step in its synthesis.
A hyperfunctioning thyroid gland, the cause of most cases of lid lag, can also be treated with modalities other than medications. Patients can be given radioactive iodine, which can selectively destroy the body’s thyroid tissue because this organ is the only part of the human body that uses iodine. Severe thyroid disease might require surgery, either because the size of the thyroid gland is causing symptoms — such as problems swallowing — or because radioactive therapy cannot be given or one reason or another — for example, during pregnancy. Surgery to remove the thyroid gland also effectively decreases the overproduction of thyroid hormone.
An important aspect in the treatment of lid lag is to control the symptoms caused by the abnormal eye function. The condition can often result in over-exposure of the surface of the eye to the environment, putting patients at risk for corneal abrasions and the sensation of having dry, gritty eyes. Lubricating eye drops can decrease some of these symptoms. Many patients tape their eyes shut at night in order to allow the surface of the eye to remain moist while they are sleeping. Eye drops containing the medication guanethidine can decrease lid lag by paralyzing some of the muscles in the eyelid that are responsible for causing this ocular abnormality.
Other therapeutic approaches can also be used to treat lid lag. Immunosuppressive medications, including corticosteroids and cyclosporine, can decrease the progression of this condition. Radiotherapy, which utilizes radioactive waves to the eye region, can help with the eye disease. Severe cases might require surgery in order to mechanically fix some of the structural abnormalities leading to this condition.
