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Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 333

Bilateral medial rectus aplasia with atypical morning glory anomaly

Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India

Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Shweta Chaurasia
Associate Professor, Strabismology, Pediatric Ophthalmology, and Neuro-Ophthalmology Services, Room No 121, Ground Floor, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1736_21

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How to cite this article:
Chaurasia S, Sukhija J, Saini M. Bilateral medial rectus aplasia with atypical morning glory anomaly. Indian J Ophthalmol Case Rep 2022;2:333

How to cite this URL:
Chaurasia S, Sukhija J, Saini M. Bilateral medial rectus aplasia with atypical morning glory anomaly. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 14];2:333. Available from: https://www.ijoreports.in/text.asp?2022/2/1/333/334905

A 25-year-old male presented with large-angled outward deviation and adduction deficit in both eyes since birth. Family history was unremarkable. Physical examination revealed a wide nasal bridge and hypertelorism. On examination of both the eyes, fundus revealed excavated disc with central neuroglial remnants, a halo of peripapillary pigmentary changes, multiple circumferentially radiating vessels from the disc-edge,[1] and hypoplastic fovea [Figure 1]a and [Figure 1]b. Conical excavation with central glial tuft was confirmed on swept-source OCT [Fig. 1c]. The patient was diagnosed with atypical morning glory anomaly because of bilaterality, normal-size, and dark-gray color of the disc. MRI-orbit revealed bilateral aplastic medial recti (a rare associated midline defect of mesenchymal origin) [Fig. 1d].[2],[3],[4],[5]
Figure 1: (a and b) Bilateral atypical morning glory anomaly with foveal hypoplasia (BCVA OU 20/100); (a, b subset) Axial T2 weighted MRI orbit demonstrating a pinpoint funnel-shaped morphologic pattern of the optic disc (yellow arrow), absent bilateral medial rectus (red arrow) and thickened lateral rectus (blue arrow); (c) swept-source OCT confirming funnel excavation and central glial tuft; (d) coronal T2-weighted MRI-orbit showing absent medial rectus on both sides (bilateral medially deviated optic nerve of exotropic eyes shown as orange arrows).

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ellika S, Robson CD, Heidary G, Paldino MJ. Morning glory disc anomaly: Characteristic MR imaging findings. AJNR Am J Neuroradiol 2013;34:2010-14.  Back to cited text no. 1
Dempster AG, Lee WR, Forrester JV, McCreath GT. The 'morning glory syndrome' — a mesodermal defect? Ophthalmologica 1983;187:222-30.  Back to cited text no. 2
Leitch RJ, Winter RM. Midline craniofacial defects and morning glory disc anomaly. A distinct clinical entity. Acta Ophthalmol Scand Suppl 1996;:16-9.  Back to cited text no. 3
Bohnsack BL, Gallina D, Thompson H, Kasprick DS, Lucarelli MJ, Dootz G, et al. Development of extraocular muscles requires early signals from periocular neural crest and the developing eye. Arch Ophthalmol 2011;129:1030-41.  Back to cited text no. 4
Görbe E, Vámos R, Rudas G, Jeager J, Harmath A, Csaba A, et al. Neuronal migration disorders, agenesis of corpus callosum, preauricular skin tag and bilateral morning glory syndrome in a term newborn infant. Clin Dysmorphol 2008;17:123-5.  Back to cited text no. 5


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