Morning glory disc anomaly

Morning glory syndrom retinography

Morning Glory Disc Anomaly (MGDA) is a rare, congenital optic disc anomaly characterized by an enlarged, funnel-shaped excavation of the optic disc. The condition is named for its resemblance to the morning glory flower, due to the appearance of the optic disc which is often surrounded by an elevated annulus of chorioretinal pigment and has radiating retinal vessels. MGDA is typically unilateral and can be associated with reduced visual acuity, field defects, and in some cases, strabismus or amblyopia.

Etiology and Pathogenesis

The exact cause of Morning Glory Disc Anomaly is not well understood, but it is believed to result from abnormal development of the optic nerve and surrounding structures during gestation. Theories suggest that it may involve abnormal closure of the embryonic fissure, leading to the distinctive funnel-shaped appearance of the optic disc. Genetic factors may play a role in some cases, although most instances of MGDA occur sporadically.

Clinical Features

Patients with Morning Glory Disc Anomaly may present with a variety of symptoms, ranging from asymptomatic to significant visual impairment. The hallmark feature of MGDA is the appearance of the optic disc on ophthalmoscopic examination, which shows a deep, bowl-like excavation with a white or pale center and a surrounding ring of pigment. The retinal vessels emerge in a radial pattern from the edges of the disc. Visual acuity in affected eyes can vary widely, and some patients may experience complications such as retinal detachment or serous macular detachment.

Diagnosis

Diagnosis of Morning Glory Disc Anomaly is primarily based on clinical examination and imaging studies. Fundus photography, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) of the orbits can help in confirming the diagnosis and ruling out other conditions with similar presentations. It is important for the diagnosis to be made by an experienced ophthalmologist or neuro-ophthalmologist, as the condition can be confused with other optic disc anomalies such as optic disc coloboma or papilledema.

Management

There is no cure for Morning Glory Disc Anomaly, and management is focused on monitoring and treating associated complications. Patients should undergo regular ophthalmologic examinations to monitor their vision and the health of the retina. In cases where retinal detachment occurs, surgical intervention may be necessary. Low vision aids and rehabilitation services can be beneficial for individuals with significant visual impairment.

Prognosis

The visual prognosis for patients with Morning Glory Disc Anomaly varies depending on the severity of the anomaly and the presence of associated complications. While some individuals may maintain stable vision, others may experience progressive visual loss. Early detection and management of complications are crucial for preserving vision.

Associated Conditions

Morning Glory Disc Anomaly can be associated with other systemic and ocular conditions. Systemically, it has been linked to transsphenoidal encephalocele and midline cranial defects in some cases. Ocularly, it may occur alongside conditions such as persistent hyperplastic primary vitreous (PHPV) and coloboma of other ocular structures.

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