Primary open-angle glaucoma in bilateral morning glory syndrome

Abstract

Objective: Case presentation of a patient with chronic primary open-angle glaucoma associated with bilateral morning glory syndrome.
Clinical case: Male patient presenting with near vision loss. He referred he could never see well with his left eye and that he had no personal or family history of significant conditions. Physical examination revealed uncorrected visual acuity of 20/20 in the right eye (RE) and of 20/200 in the left eye (LE), not improving with correction. His objective refraction was: -0.25 -0.50 165° in the RE and -0.50 in the LE; IOP in both eyes was 25 mmHg and he had an open angle (grade IV) with all its structures visible and scarce pigmentary deposits on the trabecular meshwork. Funduscopy evidenced that the structure of both optic discs was consistent with the presence of morning glory syndrome and that macular brightness was decreased. OCT revealed retinoschisis in both eyes with detachment of the inner plexiform layer with greater involvement of the left eye. The measures taken were: administration of hypotensive medical therapy with a prostaglandin analogue, a watchful waiting strategy to observe macular evolution and glaucoma follow-up with color retinography.
Conclusion: Description of a morning glory syndrome case, low-incidence dysplasia, rare because of its bilateral presentation and even less frequent because of the male gender of the patient. On the other hand, its association with primary open-angle glaucoma limits its follow-up due to the anatomical differences of the optic disc, with optic nerves included in the guidelines for additional tests used for the follow-up of glaucoma and therapeutic decision-making.