Author : Dr. Sheldon Fernandes

Ophthalmology Resident

Co- Author : Dr. Shubha NagpalProfessor & Head

Dept of Ophthalmology Bharati Vidyapeeth University

Medical College, Pune

UNILATERAL DISC ANOMALY: MORNING GLORY SYNDROME

PURPOSE• To report a rare case of optic disc anomaly.• Incidence : 1 in 10 million.

PRESENTATION

40 year old female presented with:

• Deviation of the right eye with loss of vision noticed around 10 years ago.

OPHTHALMIC EXAMINATIONRIGHT EYE LEFT EYE

BCVA PL negative 6/9

AR -5.50/-0.75x30 -1.50 DC at 90ᵒ

IOP (GAT) 16 mmHg 14 mmHg

AXL 25.00mm 22.36mm

ANTERIOR SEGMENT

Exotropia 150-200.

Pupils 5mm, not reacting to light. Rest NAD

Orthophoric.Pupil 2mm, reaction normal.Rest NAD.

FUNDUSRIGHT EYE

LEFT EYE

•Large funnel-shaped excavation in optic disc.•White, elevated, hyperplastic glial tissues, occupying the central disc. •Abnormally narrow, straight vessels, radiated from the disc margins.

Within normal limits.

USG B SCANRIGHT EYE LEFT EYE

Deep Excavated Cup Within Normal Limits

DISCUSSION• Morning Glory disc is defined as an enlarged disc with

a funnel shaped excavated peri-papillary region that is surrounded by a wide elevated annulus of chorioretinal pigment, with a central white tissue and retinal vessels that exit at the edge of the disc and run radially towards the peripheral fundus.1

• Etiology - poorly understood. • Associations - Transphenoidal basal encephalocele

- Midfacial malformations.2

• Sex >• Incidence - 1 in 10 million.• Visual acuity - 6/6 to counting fingers.• Amblyopia in Unilateral cases.• Strabismus may also be present.2

• Visual field defects - enlarged blind spot.2,3 • Serous Retinal detachment – in 30%.4

• Differential diagnosis - Optic nerve coloboma - Peripapillary staphyloma.2

• Treatment is directed towards preventing and treating the complications (Retinal Detachment).3

• Research is being performed to explore the possibilities for the treatment and prevention of this disease.4

REFERENCES• 1. Brodsky, M.C. 2010. Congenital Optic Disc Anomalies in

Pediatric Neuro-ophthalmology. 2nd ed. New York: Springer.

• 2. Lee, BJ and Traboulsi, EI. 2008. Update on the Morning Glory Disc Anomaly. Ophthalmic Genetics 29:2, p47-52.

• 3. Kindler P. Morning glory syndrome: unusual congenital optic disk anomaly. Am J Ophthalmol. 1970; 69(3):376-384.

• 4. Dovemedcom. 1. DoveMed. [Online]. Available from: http://www.dovemed.com/morning-glory-syndrome/ [Accessed 13 July 2016].