Neuro-Ophthalmic
Congenital Optic Disc Anomalies
Also known as: congenital optic disc anomaly, optic nerve head anomalies, optic nerve coloboma, optic disc coloboma, morning glory disc, morning glory syndrome, morning glory anomaly, peripapillary staphyloma
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A group of optic nerve head appearances that are present from birth or follow the shape of the eye, and do not progress the way glaucoma or disc swelling does. This record covers optic nerve coloboma, morning glory anomaly, peripapillary staphyloma, megalopapilla, myelinated nerve fibres, Bergmeister papilla, prepapillary vascular loop, the myopic tilted disc and peripapillary intrachoroidal cavitation. Optic nerve hypoplasia, optic disc drusen and optic disc pit have their own records. Most of these need a clear baseline and routine review. The work is to tell them apart from glaucoma and from a swollen disc, to watch the excavated discs for retinal complications, and to refer a young child at first diagnosis.
Recognition
Symptoms: what patients report
- Often none; found at a routine examination
- Poor vision in one eye from early childhood, with a squint, in morning glory anomaly or a large coloboma
- A long-standing field defect the patient may not have noticed
- New blur, distortion, flashes, floaters or a shadow when a retinal complication develops
Signs: what the examination shows
- Optic nerve coloboma: a yellow-white, bowl-shaped excavation with sharp borders, usually in the inferonasal disc but sometimes involving the whole disc. May accompany a small eye, coloboma of the lid, iris, ciliary body or retina, or a notched lens.
- Morning glory anomaly: usually one eye. A large, funnel-shaped, deeply excavated disc with vessels radiating straight out from its edge, a central white glial tuft and a ring of peripapillary pigment. Vision is usually poor, with amblyopia and strabismus.
- Peripapillary staphyloma: usually one eye. A deep excavation around the disc, with the disc sitting at its base. The field may show an enlarged blind spot.
- Megalopapilla: an abnormally large disc (area over 2.5 mm²) with a large, deep cup but intact rims, a normal pressure, and nerve fibre layer and ganglion cell thickness within the normal range. The field is normal or shows an enlarged blind spot.
- Myelinated nerve fibres: grey-white patches with feathered edges that follow the nerve fibre layer and can hide the retinal vessels, usually beside the disc. OCT shows a thick nerve fibre layer at the patch.
- Bergmeister papilla: a small tuft of white glial tissue in front of the disc, a remnant of the hyaloid artery; more common after premature birth.
- Prepapillary vascular loop: a raised, twisted vessel loop that leaves the disc into the vitreous and returns. Usually arterial and in one eye.
- Myopic tilted disc: an oval, obliquely set disc in a myopic fundus, usually tilted temporally, with a raised nasal border and a thick nasal nerve fibre layer on OCT.
- Peripapillary intrachoroidal cavitation: a yellow-orange crescent, usually below the disc beside a myopic conus. OCT shows a thick peripapillary choroid early and a triangular dark space later.
What OptoGuide™ covers for congenital optic disc anomalies
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting