Morning glory syndrome (MGS) is a birth defect that affects the nerve of the eye and causes poor eyesight. The syndrome is named for the morning glory flower because the characteristics of this defect resemble the flower.
Morning glory syndrome is relatively rare, as it affects only 2.6 people out of 100,000. Most people with morning glory syndrome only experience symptoms in one eye.
What Is Morning Glory Syndrome?
Morning glory syndrome, also known as morning glory disc anomaly (MGDA), is a birth defect of the optic nerve that affects vision. It is characterized by an enlarged, funnel-shaped cavity of the optic disc, the place in the eye where the optic nerve connects to the retina. The affected optic disc is larger and has a white center, which looks like a white pupil. The number of blood vessels in the eye increase, curving from the enlarged disc and spreading out like flower petals.
The term morning glory syndrome was first coined in 1970 by Doctor Peter Kindler to describe the abnormality. The increased blood vessels surrounding the malformed optic disc and nerve resemble morning glory flower petals. Most reported cases of morning glory syndrome are unilateral, affecting only one eye. Morning glory syndrome cases are usually unrelated to family genetics and are more common in females.
What Are Morning Glory Syndrome Symptoms?
Morning glory disc anomaly can occur by itself or with other eye-related and non-eye symptoms and associations. The most common eye-related symptom is poor vision in the affected eye. Vision sharpness can vary from 20/20 to very poor at 20/200, which constitutes legal blindness. People with morning glory syndrome often have visual field defects such as large blind spots. Other eye-related abnormalities include having crossed eyes (strabismus) or a lazy eye (amblyopia).
Non-eye associations may include brain disorders, including hypoplasia of the cerebral arteries and Moyamoya disease. Hypoplasia occurs when cells fail to grow normally, resulting in an organ or body part being smaller than the normal size.
Moyamoya disease is a brain disorder caused by blocked arteries. The name “moyamoya,” which means “puff of smoke” in Japanese, describes the tiny vessels tangled together blocking the blood vessels.
People with symptoms not completely eye-related typically still have physical abnormalities such as a wide head, depressed nasal bridge, and defects in the mid-upper lip.
Other reported morning glory syndrome associations include PHACE syndrome. This is a rare disorder characterized by various abnormalities occurring together and affecting multiple parts of the body.
What Causes Morning Glory Syndrome?
Morning glory disc anomaly seems to be caused by the optic nerve failing to form completely when a baby is developing. The most severe issue is morning glory syndrome retinal detachment, which occurs when the tissue layer at the back of the eye pulls away from the tissue around it. This occurs in about 26% to 38% of people with morning glory syndrome.
How Is Morning Glory Syndrome Diagnosed?
Morning glory syndrome is commonly associated with other abnormalities and is usually diagnosed based on signs and symptoms. The associated complications make it challenging to get a clear diagnosis. Morning glory syndrome is sometimes misdiagnosed as an optic nerve coloboma due to their similarities. In both cases, the optic nerve fails to form completely during development.
Recent studies have used Magnetic Resonance Imaging (MRI) to more accurately diagnose morning glory syndrome. MR imaging can provide more well-rounded information regarding eye formation compared to pure inspections. Results of the studies show that imaging may provide added value in several ways, including better diagnoses and discovery of other health complications.
What Are Morning Glory Syndrome Treatment Options?
Occlusive therapy is commonly used as a treatment option for people with morning glory syndrome. This treatment method helps to readjust the affected eye by covering up the healthy eye to restrict its use. Occlusive therapy is especially effective when used to treat morning glory syndrome associated with a lazy eye. These cases require early treatment and regular follow-ups to increase the probability of improving vision.
The effectiveness of occlusive therapy depends highly on the age of the person with morning glory syndrome and the associated complications. People with only one eye affected or severe structural abnormalities of the optic nerve have benefited from occlusive therapy when the treatment was done early.
Morning glory syndrome usually cannot be cured, though. In addition to poor vision, people with morning glory syndrome are more likely to experience symptoms such as retinal detachment, amblyopia, and strabismus. Realignment surgery for the eye and treatment of amblyopia may help with vision, but it is rare to see huge improvements.
Treatment of morning glory syndrome with associated abnormalities requires an interdisciplinary approach because multiple systems of the body are affected. Most of the time, this interdisciplinary approach includes neurosurgery (surgery of the nervous system), interventional radiology (a way to diagnose and treat cancers), otolaryngology (the study of diseases of the ear and throat), and dentistry.
People diagnosed with morning glory syndrome during routine exams can receive further imaging and tests to see if there are associated complications. Specific subspecialists can then be consulted to figure out the best path for treatment.
The Takeaway
Morning glory disc anomaly, more commonly known as morning glory syndrome, is a birth defect affecting the optic nerve that causes poor vision. Morning glory syndrome may be associated with abnormalities that are not always eye-related. Eye-related complications include morning glory syndrome retinal detachment, crossed eyes, or a lazy eye. Non-eye associations include brain disorders, such as a lack of brain cell growth or blockage in the brain caused by blood vessels.
Early diagnosis of morning glory syndrome increases the likelihood of treatment improving vision. Occlusive therapy is a common treatment option for morning glory syndrome. Related complications may require an interdisciplinary approach to increase treatment effectiveness.
