Contractile morning glory disc anomaly associated with total retinal detachment: a case report

Morning glory disc anomaly is a rare congenital optic nerve head malformation. The contractile variant, characterized by rhythmic pulsatile movement of the optic disc, is exceptionally uncommon, and detailed documentation of its dynamic features using multimodal imaging remains limited. This report aims to describe the clinical characteristics and imaging findings of a child with contractile morning glory disc anomaly and associated retinal complications. A 3-year-old girl presented with progressive esotropia and severe visual impairment in the right eye. Comprehensive ophthalmic examination under general anesthesia was performed, including color fundus photography, optical coherence tomography, ultrasonography with color Doppler imaging, and wide-field fluorescein angiography. Multimodal imaging revealed a markedly enlarged, funnel-shaped excavated optic disc with radially arranged abnormal retinal vessels and indistinct arteriovenous differentiation. Rhythmic contractile movement of the optic disc was observed on dynamic RetCam imaging and could be elicited by gentle external pressure on the globe, with no apparent association with cardiac or respiratory cycles. The affected eye exhibited total retinal detachment involving the macula. Peripheral retinal non-perfusion and vascular leakage were observed on fluorescein angiography; however, their relationship with the optic disc anomaly and retinal detachment remains uncertain. Peripheral retinal laser photocoagulation was performed, and the retinal detachment remained anatomically stable during follow-up, with visual acuity remaining at hand motion. Contractile morning glory disc anomaly is a rare developmental optic nerve head disorder with distinctive dynamic features. Dynamic imaging provides valuable visualization of the contractile behavior of the malformed optic disc and may assist in diagnosis and risk assessment. Retinal detachment and associated vascular abnormalities may occur in these patients, although their underlying mechanisms require further investigation.