(What's the story) morning glory? MRI findings in morning glory disc anomaly.

PURPOSE: Morning glory disc anomaly (MGDA) is a rare congenital ophthalmologic disorder. Historically it has been diagnosed fundoscopically, with little in the literature regarding its imaging findings. The purpose of this study is to further characterize the orbital and associated intracranial magnetic resonance imaging (MRI) findings of MGDA in our tertiary pediatric center. METHODS: A retrospective review was performed of fundoscopically-diagnosed cases of MGDA, that had been referred for MRI. All MRI studies were scrutinized for orbital and other intracranial abnormalities known to occur in association with MGDA. RESULTS: 18 of 19 cases of MGDA showed three characteristic MRI findings: funnel-shaped morphology of the posterior optic disc, abnormal soft tissue associated with the retrobulbar optic nerve, and effacement of adjacent subarachnoid spaces. The ipsilateral (intraorbital) optic nerve was larger in one patient and smaller in six. The ipsilateral optic chiasm was larger in two patients and smaller in one. CONCLUSION: This study represents a comprehensive radiological-led investigation into MGDA. It describes the most frequently-encountered MRI findings in MGDA and emphasizes the importance of MRI in this cohort, i.e., in distinguishing MGDA from other posterior globe abnormalities, in assessing the visual pathway, and in screening for associated intracranial abnormalities - skull base/cerebral, vascular, and facial. It hypothesizes neurocristopathy as an underlying cause of MGDA and its associations. Caliber abnormalities of the ipsilateral optic nerve and chiasm are a frequent finding in MGDA. Optic pathway enlargement should not be labeled "glioma". (239/250).

Pain relief in patients receiving periocular botulinum toxin A.

PURPOSE: We hypothesized that patients with benign essential blepharospasm and hemifacial spasm experience relief of headache and eye pain after botulinum toxin injections. METHODS: A retrospective chart review of 85 patients who had received botulinum toxin injections at the University of Minnesota for treatment of benign essential blepharospasm and hemifacial spasm was conducted. A prospective telephone questionnaire was used to ascertain details regarding improvement of headache and eye pain. RESULTS: Of the 85 patients (34 men, 51 women), 20 patients (23.5%) had headaches and 29 (34.1%) had eye pain. Ten of 20 (50.0%) headache-positive patients and 24 of 29 patients (82.8%) with eye pain had reduction in their pain after botulinum toxin injections. CONCLUSION: The findings of this study support the use of botulinum toxin for headache and eye pain relief in patients with benign essential blepharospasm and hemifacial pain. In addition, with the expanding uses of botulinum toxin, the results support its antinociceptive effects. Further investigation should continue in the mechanism of botulinum toxin's effects on pain.

Thyroid eye disease presenting after cosmetic botulinum toxin injections.

A 53-year-old woman with left periorbital swelling 4 days after botulinum toxin injection in the lateral canthal area presented after noticing left eye prominence. Physical examination demonstrated proptosis and eyelid retraction. Computed tomography of the orbits confirmed extraocular muscle enlargement consistent with thyroid eye disease. In this case, the patient had development of proptosis after receiving botulinum toxin injections. Although the proptosis may represent progression of the patients' thyroid eye disease, it is worthwhile to consider incitation by botulinum toxin as a possible cause given its widespread use.