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Morning glory anomaly is a rare congenital malformation of the optic nerve. [2] It is named for its resemblance to the morning glory flower. [3] When it is associated with systemic signs and symptoms, it is known as morning glory syndrome. Acute posterior multifocal placoid pigment epitheliopathy APMPPE is an acquired inflammatory uveitis that belongs to the heterogenous group of white dot syndromes in which light-coloured yellowish-white lesions begin to form in the macular area of the retina.
Early in the course of the disease, the lesions cause acute and marked vision loss if it interferes with the optic nerve that ranges from mild to severe but is usually transient in nature.
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APMPPE is classified as an inflammatory disorder that is usually bilateral and acute in onset but self-limiting. The lesions leave behind some pigmentation, but visual acuity eventually improves even without any treatment providing scarring doesn't interfere with the optic nerve. It occurs equally between men and women with a male to female ratio of 1. Mean onset age is 27, but has been seen in people aged 16 to Recurrent episodes can happen, but are extremely rare.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy
The onset of ocular symptoms are usually preceded by episode of viral or flu-like symptoms such as fever, cough or sore throat however this is not always the case. Patients can typically present erythema nodosum , livedo reticularis , bilateral uveitis , and sudden onset of marked visual loss associated with the appearance of multiple lesions in the retina. These lesions may be colored from grey-white to cream-shaded yellow.
Other symptoms include scotomata and photopsia. In weeks to a month times the lesions begin to clear and disappear with prednisone leaving behind areas of retinal pigment epithelial atrophy and diffuse fine pigmentation scarring. Rarely choroidal neovascularization occur as a late onset complication. The cause of the inflammation remains unknown. It is hypothesized that it may occur as an autoimmune response to a mild infection, or it may be viral in nature, as evidenced by the preceding flu-like illness that generally accompanies it.
Van Buskirk et al. However, a novel hypothesis was proposed implicating a direct neurotropic infection as a possible underlying cause given the dynamic changes observed along the neuronal pathway of the retina [ 14 ]. The original description categorized APMPPE as a self-limiting condition with a good prognosis, but the disease can be recurrent and result in significant visual loss. In cases where lesions appear to be interfering with the optic nerve, methyl prednisone is prescribed, but in recurrent disease an antimetabolite agent may be indicated.
Vision improves in almost all cases. In rare cases, a patient may suffer permanent visual loss associated with lesions on their optic nerve. Rarely, coexisting vasculitis may cause neurological complications. These occurrences can start with mild headaches that steadily worsen in pain and onset, and can include attacks of dysesthesia. This type of deterioration happens usually if the lesions involve the fovea.
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Wikidata item. Eye disease causing lesions in retina. Medical condition. Signs and symptoms [ edit ]. Cause [ edit ]. Diagnosis [ edit ]. Management [ edit ]. Prognosis [ edit ]. See also [ edit ]. References [ edit ]. J Ophthalmic Inflamm Infect. PMC PMID British Journal of Ophthalmology.