
A 50-year-old woman presents with a 4-day history of a sensation of pressure around the left eye, along with perilimbal redness and photophobia. Visual acuity is 20/20 in the right eye and 20/50 in the left eye. Pupil examination reveals a sluggish but reactive left pupil, and no relative afferent pupillary defect is observed with the swinging flashlight test. Measurement of intraocular pressure by applanation tonometry is 18 mm Hg bilaterally. The corneal surface does not stain with fluorescein. The patient does not have a palpable left or right preauricular lymph node. She has no ocular history of note, and has had no ocular surgeries or trauma. Her medical, family, and medication histories are noncontributory. She denies any occurrence of skin rashes, joint pains, bowel or bladder symptoms, mouth or genital ulcers, fever, chills, night sweats, or weight loss, but does note increasing shortness of breath, dry cough, and chest discomfort.
The most likely diagnosis is
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Corneal ulcer
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Angle closure glaucoma
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Acute anterior granulomatous uveitis
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Viral conjunctivitis
Answer on page 896
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