Collier's sign

Figure 1. Collier’s sign in a 70-yo-man who suffered a right midline thalamic/rostral midbrain hemorrhagic stroke causing a pretectal (Parinaud's) syndrome. There was prominent eyelid retraction (Collier's sign), a left pseudo-abducens, and upgaze palsy with convergence retraction nystagmus. Eyelid retraction is thought to be related to damage of the M-group, which is adjacent to the riMLF. The M-group sends projections to the central caudal subnucleus of the oculomotor nucleus that innervates the levator palpebrae muscles. Disruption of these pathways can lead to eyelid retraction. (Figure courtesy Dr. Daniel Gold, The Daniel Gold Collection, Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu, Spencer S. Eccles Health Sciences Library, University of Utah, Reference URL https://collections.lib.utah.edu/ark:/87278/s6797vq6

Collier’s sign (posterior fossa stare, Figure 1) is lid retraction in primary gaze seen with lesions involving the area of the rostral midbrain, aqueduct and posterior third ventricle, especially the region of the posterior commissure. (1) Eyelid retraction is abnormal lid position due to elevation of the upper lid, with the lid resting at the upper limbus or with a rim of sclera showing above the limbus. Thyroid disease is a common cause of lid abnormalities, including lid retraction in primary gaze (Dalrymple's sign), infrequent blinking (Stellwag’s sign), and lid lag in downgaze (von Graefe's sign). Lid retraction with posterior commissure lesions is bilateral, but sometimes asymmetric, and often associated with impaired upgaze. With Collier's sign, the levators relax appropriately and the lids usually descend normally on downgaze without lagging behind as they do in thyroid eye disease. (2) On return to primary gaze, the lid retraction reappears and may worsen with attempted upgaze. Circumscribed midbrain lesions may cause eyelid retraction with minimal impairment of vertical gaze. (1)

References

1. Galetta SL, Gray LG, Raps EC, Schatz NJ. Pretectal eyelid retraction and lag. Ann Neurol. 1993;33:554-7.

2. Walsh FB. Hoyt WF. Clinical neuro-ophthalmology. 3d ed. Baltimore, Williams & Wilkins, 1969.