BACKGROUND: In 1970 Kindler coined the term morning glory syndrome in his description of 10 cases of unusual congenital optic disk anomalies. The anomaly consists of an enlarged, excavated optic disk with a central mass of glial hyperplasia. The disk is frequently surrounded by an annulus of elevated chorioretinal pigment disturbance. The vascular pattern is typically abnormal with the vessels emerging radially from the edge of the enlarged disk. Morning glory disc anomaly (MGDA) is usually unilateral with acuities reported between 20/200 to count fingers. The common presenting signs of MGDA are strabismus and/or poor fixation. Myopic anisometropia may also be present. Functional amblyopia is frequently overlooked as a contributing factor in the patient’s acuity loss. This case demonstrates that although MGDA is present, aniso-strabismic amblyopia contributed to the patient’s vision deficit.
CASE REPORT(S). A 17-month-old Hispanic female presented with esotropia and poor fixation OD since birth. At the initial examination the patient was unable to fixate objects with OD. Teller acuity was 20/100 equivalent OS. Moderate compound myopic astigmatism was found OD and low compound hyperopic astigmatism was found OS. A variable angle constant esotropia was present OD. Pupil testing revealed an APD OD. Anterior segment evaluation revealed normal structures OU with OD being micro-ophthalmic. Dilated examination revealed MGDA OD and OS was normal. A polycarbonate spectacle prescription was given and part-time direct patching therapy was instituted. Over a 14-month period the acuity improved to 20/64 OD and 20/40 OS by Cardiff. OD acuity remained at 20/64 for the next 11 months and OS improved to 20/25.
CONCLUSIONS. Visual acuity loss in patients with MGDA may not be solely due to optic nerve pathology. Functional amblyopia may contribute to visual loss in unilateral cases of MGDA; thus, refractive correction and a trial of occlusion therapy is warranted in cases involving infants and young children.