REPERT MED CIR. 2024;33(1):84-87

de Medicina y Cirugía

R E S U M E N

INFORMACIÓN DEL ARTÍCULO

SSN: 0121-7372 • ISSN electrónico: 2462-991X

Wilson Carvajal Rico MD

Andrea Rodríguez Salas MD

Introducción: Se describen los signos clínicos de la anomalía de Morning Glory en una paciente femenina. Aunque esta

anomalía es de baja prevalencia, la reportamos por la importancia del diagnóstico temprano debido a la asociación con

alteraciones vasculares del sistema nervioso central que eventualmente son tratables. Objetivo: describir esta anomalía del disco

óptico en una paciente atendida en el Hospital de San José, Bogotá. Métodos: búsqueda en la literatura de las manifestaciones

clínicas, incidencia y patologías asociadas. Presentación del caso: mujer que consulta por pobre agudeza visual del ojo derecho

cuya fundoscopia reveló una excavación cónica con disco óptico displásico y tejido glial alrededor de la pupila en 360 grados,

pigmento retinocoroideo y aumento de los vasos retinianos que emergen del disco en distribución radial.

Palabras clave: anomalía llamada amanecer o mañana de esplendor de la papila óptica, desarrollo del neuroectodermo, vasos retinianos,

distribución radial.

Este es un artículo Open Access bajo la licencia CC BY-NC-D (http:// creativecommons.org/licenses/by-nc-nd/4.0/)

Reporte de caso

Rare ocular disorder of the optic Rare ocular disorder of the optic

disc resulting from a defect on the disc resulting from a defect on the

development of the neuroectoderm: development of the neuroectoderm:

morning glorymorning glory

disc anomaly disc anomaly

Trastorno ocular infrecuente del disco óptico resultante de Trastorno ocular infrecuente del disco óptico resultante de

un defecto en el desarrollo del neuroectodermo: anomalía un defecto en el desarrollo del neuroectodermo: anomalía

de de

morning glorymorning glory

Associate Professor of Ophthalmology at Hospital de San José and Fundación Universitaria de Ciencias de la Salud. Bogotá DC, Colombia. Property/

nancial interests: None

Ophthalmology at Fundación Universitaria de Ciencias de la Salud. Bogotá DC, Colombia.

Historia del artículo:

Fecha recibido: abril 19 de 2021

Fecha aceptado: octubre 28 de 2021

Autor para correspondencia:

Dr. Wilson Carvajal

richardoftal@hotmail.com

DOI

10.31260/RepertMedCir.01217372.1187

de Medicina y Cirugía

Vol.

N°1 . 2024

REPERT MED CIR. 2024;33(1):84-87

de Medicina y Cirugía

ABSTRACT

INTRODUCTION

Introduction: We describe the clinical ndings of morning glory optic disc anomaly, in a female patient. Despite the low

prevalence of this optic disc malformation and although it has no specic treatment, we report this case, for timely diagnosis

is important for associated vascular and central nervous system abnormalities may eventually be treated. Objective: to report

this case of morning glory optic disc anomaly in a patient seen at Hospital de San José, Bogotá. Study design: case report.

Methods: A search in the literature on the incidence, ophthalmological manifestations, clinical presentation and concomitant

pathologies of morning glory optic disc anomaly, was conducted. Case report: female patient that consulted for decreased

visual acuity in the right eye. Right eye fundus examination revealed a funnel-shaped excavation, dysplastic optic disc and glial

tissue covering the peripapillary region circumferentially (360°), chorioretinal pigmentary changes, and increased number of

retinal vessels emerging from the optical disc in a radial pattern.

Keywords: morning glory disc anomaly, neuroectodermal development, retinal vessels, radial distribution.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Morning glory disc anomaly (MGDA) was initially

described in German literature by Handmann in 1929

but it was Kindler in 1970 who rst termed the anomaly

morning glory disc anomaly for its similarity to the morning

glory ower due to sub-retinal uid content in the disc area

that creates the delusion of petals coming out of the optic

nerve.

 This anomaly is characterized by an enlarged optic

disc and a central white glial tuft

4,5

, deep excavation, lack of

regularity in the contour, pigment and scleral alterations and

peripapillary retinal vessels emerging radially in a straight

course.

3,6

Other associated ocular abnormalities are macular

capture and lutein pigment visualized in the outer segment

of the defect.

1,3,7

The anomaly is typically unilateral and is

not an inherited condition.

Visual acuity is poor, but about

30% of patients improve to a best corrected visual acuity

of 20/40, they can also refer visual eld defects including

hemianopia or scotoma. Strabismus and leukocoria are

other frequent reasons for consultation, especially in

children, and may be related with persistent hyperplastic

primary vitreous, cataracts, nystagmus, ciliary body cysts,

lens coloboma, optic nerve drusen, microphthalmia and

intraocular calcications.

3,8,9

MGDA is seen more commonly

in females and the incidence in the world population is very

low,

being less common in Afro-descendants.

One of the most common intraocular complications is

non-rhegmatogenous retinal detachment which runs from

the optic nerve head across the inner layer of the eye

through the scIeral apperture causing continuous traction

with axial displacement of the optic nerve. There are

multiple systemic alterations such as: midfacial and nervous

system anomalies such as hypertelorism, cleft lip and

cleft palate. Other associated ndings are transphenoidal,

sphenoethmoidal, sphenopharyngeal, and transethmoidal

encephalocele. Agenesis of the corpus callosum, endocrine

alterations due to pituitary dysfunction, hormonal

alterations and diabetes insipidus have been reported in some

patients.

1,3

Cerebrovascular anomalies such as moyamoya

disease which features intellectual disability, cerebral stroke

and convulsions, have also been demonstrated.

Aortic

arch, subclavian and carotid aneurysms, and capillary facial

hemangiomas are also related with this syndrome.

Imaging studies allow identifying abnormalities related to

MGDA, such as intracranial or vascular alterations which

may require urgent surgical intervention. Ultrasonography

B-scans allow detecting intra-ocular calcications and

overhanging retinal tissue covering a scleral posterior

staphyloma.

Computed tomography is useful for diagnosing

posterior scIeraI staphyloma, optic nerve thickening

and calcications.

Magnetic resonance imaging usually

demonstrates a funnel-shaped optic disc with elevation of

the adjacent retinal surface, and alterations of the distal

intra-orbital segment of the optic nerve with eacement

of the regional subarachnoid spaces and discontinuity of

the uveoscleral coat. MGDA appears to be the result of a

failure of normal neuroectodermal development before the

seventh week of embryonic growth

along with primary

mesenchymal abnormality, anomalies of the relative growth

between mesoderm and ectoderm or an abnormal closure

of the embryonic ssure. The PAX6 gene is thought to be

involved

in the genetic changes originating MGDA.

CASE PRESENTATION

A 51-year-old female patient who presented with a history

of alveolar diuse hemorrhage associated with microscopic

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polyangiitis with positive anti-neutrophil cytoplasmic

antibodies treated with cyclophosphamide, severe mitral

insuciency, rapidly progressive glomerulonephritis

managed with hemodialysis, pulmonary embolism treated

with anticoagulant therapy, pulmonary hypertension,

normocytic anemia, peptic acid disease, secondary

hyperparathyroidism and depressive disorder. Patient was

referred to the ophthalmology service for acute redness of

the right eye of 10 hour duration, following a hemodialysis

associated with marked hypertension. Ophthalmologic

history was unremarkable for patient stated having no

surgical or family history and no prescribed glasses.

Patient underwent detailed ophthalmologic examination

with the following results: Retinoscopy: right eye (OD):

best corrected visual acuity: 20/150, 5.25-0.50 x 0°, left

eye (OS): 20/200, 3.00-0.75 x 170°. Exophthalmometry:

15 mm/16 mm; Biomicroscopy OD: dermatochalasis,

telangiectasia of the upper eyelid margin, perilimbal

superior and inferior subconjunctival hemorrhage, clear

cornea, anterior chamber: no cells, lens: incipient nuclear

sclerosis; OS: white and quiet conjunctiva, clear cornea,

formed anterior chamber, no cells, lens: incipient nuclear

sclerosis; Mean intraocular pressure: 14 mm Hg in both

eyes. Fundoscopic examination OD (gure 1): peripapillary

abundant glial tissue, cup/disc ratio (C/D) 0.3, 360° scleral

crescent, peripapillary retinal pigment and increased

number of retinal vessels emerging from the optical disc

radially, attached retina and no alterations in the periphery;

Figure 1 A y B. Optic nerve of the right eye. Source: the authors.

OS (gure 2): clear cornea, round-shaped papilla, C/D 0.2,

normal neural ring, dened contour, macula: no retinal

light reex, attached retina. Diagnosis: subconjunctival

hemorrhage in the right eye, morning glory disc anomaly in

the right eye, and refractive amblyopia in the left eye.

Figure 2. Optic nerve of the left eye. Source: the authors.

DISCUSSION

Anatomic alterations of the optic nerve and of the retina

similar to those described in the world literature, were

found in our patient, the optic disc was enlarged with a

funnel-shaped optic nerve covered by glial tissue and lack of

regularity in the contour, peripapillary pigmentary changes

and straight retinal vessels emerging in a radial spoke-like

pattern.

1,3

Morning glory disc anomaly is usually associated

with low vision

, which coincides with our case report,

since the patient had a best corrected vision of 20/200 in the

aected eye. Our case was a female patient and agreed with

the highest prevalence of gender distribution reported in

the literature, and unilateral presentation is more frequent

as in our patient.

CONCLUSION

Morning glory disc anomaly can be found during a regular

eye check-up. It´s low incidence prompts appropriate

recognition of its signs and symptoms amongst physicians of

various specialties in order to achieve an accurate diagnosis

and provide timely treatment to these patients, taking into

account that some cases may require urgent intervention.

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