An 83-year-old Caucasian woman presented with decreased vision in her left eye with a small iris hemorrhage on the inferotemporal pupillary margin at the 4 o’clock position, which extended anteriorly in the anterior chamber. The patient described a white cloud obscuring her vision. After her daughter patched her left eye for two hours, she was able to see normally again.
Her medical history was significant for diabetes, hypertension and several small strokes three years prior. She stated that her blood sugar were under control. Visual acuity with correction was 20/40 in the right eye and 20/25 in the left eye. Her right pupil was 4 to 3.75 mm and her left pupil was 2 to 1.75 mm. Both pupils were sluggish, but there was no afferent pupillary defect. IOP was 12 mmHg in the left eye. Both eyes had a +2 nuclear sclerotic cataract.
The assessment was transient monocular visual loss in the left eye, concerning for amaurosis fugax and diabetes.
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