Looking Right

If you suspect a lid lag or hyperthyroidism, ask the patient to follow your finger again as you move it slowly from up to down in the midline. The lid should overlap the iris slightly throughout this movement.

In the lid lag of hyperthyroidism, a rim of sclera is seen between the upper lid and iris; the lid seems to lag behind the eyeball.

Finally, test for convergence. Ask the patient to follow your finger or pencil as you move it in toward the bridge of the nose. The converging eyes normally follow the object to within 5 cm to 8 cm of the nose.

Poor convergence in hyperthyroidism

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