A Bright Curtain Drawing Down

A 68-year-old female with a medical history including diabetes mellitus, migraines, thyroid eye disease and bilateral posterior chamber intraocular lens placement two years prior presented after one year of painless, intermittent, unilateral episodes of "a bright curtain drawing down" in her left eye leaving her visual field white for several hours before gradual, complete resolution of symptoms. She first presented to the ER where she was diagnosed with amaurosis fugax. Stroke workup was unremarkable. Following aspirin therapy, she developed nearly 30 subsequent episodes in one year. She was ultimately referred to neuroophthalmology clinic for suspected retinal migraines. VA, pupils, and IOP were normal with a stable right proptosis and persistent left supraduction deficit. Slit lamp examination was notable for multiple left iris transillumination defects. Vitreous was normal OD and diffusely hazy OS. Optic nerves were normal. Gonioscopy revealed 4+ pigments in the left angle vs 1+ in the right. HVF and OCT Optic Nerve were both normal.