von graefe's sign von graefe's sign von graefe's sign is the lagging of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter (graves' disease). it is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis. von graefe's signdifferential diagnosisexophthalmic goiter 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. it occurs in paramyotonia congenita. a pseudo graefe's sign is most commonly manifested in just one eye but can occasionally be observed in both. the reason only one eye is affected is not yet clear.