Clinical characteristics and strabismus patterns in 61 patients with morning glory syndrome: a retrospective study

To analyze the frequency, type distribution, and related clinical characteristics of strabismus in patients with morning glory syndrome, and to provide evidence for clinical evaluation and intervention. Clinical data of patients with morning glory syndrome who visited our hospital between August 1, 2024 and December 31, 2025 were retrospectively analyzed. Visual acuity, refractive status, fixation ability, associated ocular abnormalities, and strabismus examination findings were collected, and statistical analyses were performed. A total of 61 patients were included, involving 67 affected eyes; 55 patients had unilateral involvement and 6 had bilateral involvement. The median age at initial presentation to our hospital for evaluation of MGS was 5 years. Refractive abnormalities were common, with anisometropia observed in 45.2% of patients. Absent fixation was observed in 42 affected eyes, accounting for 62.7% (42/67). The frequencies of cataract and retinal detachment were 39.3% and 21.3%, respectively. Among the 59 patients included in the strabismus analysis, 52 were diagnosed with strabismus, yielding a frequency of 88.1%. Because some patients had horizontal strabismus combined with vertical strabismus or dissociated vertical deviation, strabismus types were classified as non-mutually exclusive categories. Exotropia-related types were the most common, observed in 23 patients (44.2%), followed by vertical strabismus-related types in 18 patients (34.6%), esotropia-related types in 16 patients (30.8%), DVD-related types in 4 patients (7.7%), abducens nerve palsy in 3 patients (5.8%), and variable/unstable deviation in 2 patients (3.8%).Patients with esotropia-related types had binocular spherical equivalent refraction that tended to be more hyperopic than that of patients with exotropia-related types, and the difference was statistically significant ( P = 0.029). Four patients underwent strabismus corrective surgery, and short-term postoperative ocular alignment improved in all cases. Patients with morning glory syndrome have a high frequency of strabismus, with exotropia-related types being the most common and frequently present with refractive abnormalities, fixation dysfunction, and other ocular abnormalities such as cataract and retinal detachment. Clinical evaluation should emphasize ocular alignment, fixation ability, and refractive status, together with anterior segment and fundus examinations, to facilitate early identification of associated ocular abnormalities, individualized intervention, and long-term follow-up.