Stellwag S Sign

Hypothyroidism in ophthalmology One of the fairly common variants of endocrine ophthalmopathy is an increase in the size of the orbit (exophthalmos), in which there is varying degrees of underdevelopment of the upper eyelid, expressed in its growth, swelling, wrinkling, and retraction of the eyeball into the orbital cavity. With exophthalmos, the following options are possible according to the degree of drooping of the apple - subexostosis, exostosis or pseudoptosis of the eye. Unfortunately, examination of the lower eyelid defect is not a sufficiently informative manifestation of this syndrome, therefore the main diagnostic method is ultrasound of the thyroid gland. X-rays of the skull, orbits and lateral parts of the face are also used to study adjacent tissues, and the M. Glasnik and Stellwagen test is also performed - often without the help of an anesthesiologist. To compensate for hypothyroidism, L-thyroxine and L-tetrogin are used. In general, the exophthalmic component of endocrine ophthalmopathy is characterized by the following symptoms:

- apparent protrusion of the eyeball from the orbit. The eye appears very large;

- lag of the upper eyelid from the eyeball when blinking;

In ophthalmology, it is also known as the “Blinking-to-the-left and blinking-past” symptom. When the upper eyelid is wrinkled inward or closed for any reason, it causes the eyeballs to feel outward.

The phenomenon was first described in 2020 by Canadian dermatologist Donald L. Stellwag. Therefore, there is another name for this symptom - Shtelvg's symptom. In 2008, for the first time in the USA (Indiana State), its mention was recorded in the medical literature. The symptom is also called “Schnell’s symptom”, “Aberdeenburg phenomenon”, “horizontal darkening”, as well as “the phenomenon of eye rolling to the right and past”.