When optic disc elevation is encountered on funduscopic examination, the first concern is whether it represents true disc oedema. We present a patient who was urgently referred to us by a retinal specialist because of unilateral “disc swelling.” Further evaluation suggested that the patient had a congenital optic disc anomaly that was atypical in appearance, but most likely a variant of the morning glory disc anomaly (MGDA). A 40 year old African-American woman with no visual complaints went to her local optometrist for a routine eye examination. At the optometrist’s office she was told that “in the back of her right eye she had a dark spot with a ring around it” and was referred to a retinal specialist. The retinal specialist found a mildly decreased visual acuity and a “swollen disc” in the right eye and the patient was referred for neuro-ophthalmic consultation. To her knowledge, she previously had never had a dilated funduscopic examination. Best corrected visual acuity was 20/30 distance and J1 near in the right eye and 20/20 distance and J1+ near in the left eye. There was a 0.9 log unit right relative afferent pupillary defect. Her colour vision, external examination, slit lamp biomicroscopy, intraocular pressures, and motility were all normal in both eyes. Funduscopic examination was normal in the left eye with an optic nerve cup to disc ratio of 0.4. The appearance of her right optic nerve (Fig 1) was that of an elevated ring around the centre of the disc, interrupted from about 7 o’clock to 9 o’clock by an area of pigmentation. The vasculature was mildly obscured as it crossed the elevation. There was no venous engorgement, haemorrhage, cotton wool spots, or exudate. Funduscopic examination gave the appearance of a peripapillary excavation of retina and retinal pigment epithelium surrounding the elevated …