A 63-YEAR-OLD white man was referred for evaluation of a single transient visual disturbance 6 months earlier. A subsequent magnetic resonance image of the brain was normal.
On examination, visual acuity was 20/20 OU. The pupils of both eyes were 4 mm, central, round, and reactive to light. Slitlamp examination was notable for the incidental finding of marked bilateral, symmetric iris stromal atrophy (Figure 1). The pigment epithelium was clearly visible through the centrally attenuated iris stroma as a chocolate brown color, with the pupillary sphincter standing out as a tan ring. The peripheral iris stroma was minimally attenuated and appeared light blue. There were no iris transillumination defects. The lesser vascular circle and pupillary ruff pigment appeared normal. Gonioscopy revealed open angles in both eyes, and intraocular pressures were 16 mmHg OU. Fundus examination disclosed pink, sharp discs with a cup-disc ratio of 0.35 OD and 0.40 OS. A Humphrey visual field 30-2 was full in both eyes.