Eye eponymous signs - ED primer
Eponymous signs are bedside clues named after their describers. In the emergency department they are high‑yield findings that should prompt condition‑directed assessment and timely specialist escalation rather than definitive ED management.
This section covers the common exam‑and‑clinically relevant signs: Shafer’s (tobacco‑dust) sign, von Graefe’s and Rosenbach’s signs (thyroid eye disease), Hutchinson’s sign (shingles/HZO) and Gunn’s sign (hypertensive retinopathy). UK referral urgency language (e.g.
“refer immediately/urgently” from NICE NG127) is used to standardise ED communication.
Quick comparison
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Shafer’s sign (tobacco‑dust)
What it is
Dark pigment granules in the anterior chamber caused by retinal pigment epithelial cells dislodged through a retinal break into the vitreous and anterior chamber. Strongly suggestive of a rhegmatogenous retinal tear/detachment.
Typical history/exam
- Sudden new floaters and flashes (photopsia).
- Curtain or sectoral visual field loss; blurred vision.
- Slit‑lamp shows pigmented cells in the anterior chamber.
- Fundoscopy may show a tear or detachment if media are clear.