Teaching NeuroImages: Morning glory disc anomaly

A 7-month-old girl presented with strabismus. Funduscopy (figure, A) revealed a typical morning glory disc anomaly (MGDA) of the right eye, including an enlarged funnel-shaped excavation of the optic disc, a peripapillary pigmented ring, and a radial aspect of the retinal vessels. Brain MRI (figure, B) showed excavation and abnormal tissue at the optic nerve insertion consistent with glial tuft. The symptoms caused by a MGDA are various and not always present: variable visual acuity (often poor) for the affected eye, visual field defects, and enlarged blind spot are the most common symptoms. Serous retinal detachments can occur. The pathology is usually unilateral. MRI helps in making the diagnosis and detecting associated intracranial abnormalities,1 especially midline anomalies like transphenoidal basal encephalocele and moyamoya syndrome. There is no treatment for MGDA; however, optimizing visual acuity is important to prevent amblyopia.2