["Morning glory syndrome" and "Handmann's anomaly" in congenital macropapilla. Extreme variants of "confluent optic...

Seventeen optic disks with morning glory syndrome were measured in absolute and relative size units (millimeters and parapapillary retinal vessel caliber) in 5 and 12 eyes, respectively. Their respective mean areas were 7.47 +/- 2.63 mm2 and 7.84 +/- 4.96 mm2. They were significantly (Mann-Whitney test) larger than 457 unselected normal optic nerve heads (2.69 +/- 0.70 mm2; p less than 0.0001) and 15 optic disks with pits (4.84 +/- 1.42 mm2; p less than 0.001). They are the largest optic nerve heads, probably with constant postnatal size, measured so far, and form part of a spectrum of optic disk anomalies and diseases whose frequency correlates with the size of the optic disk. This spectrum includes abnormally small optic nerve heads with increased prevalence of drusen, pseudopapilledema and nonarteritic anterior ischemic optic neuropathy, asymptomatic macrodisks with physiologic, "pseudoglaucomatous" macrocups, symptomatic macrodisks with pits and, finally, optic nerve heads with morning glory syndrome. The last-mentioned may be considered an extreme variation of optic disks with pits which have combined to form a single macropit covering the entire optic nerve head.