A 69-year-old woman comes to her PA for evaluation of “gritty,” red, itchy eyes for the past three months. The patient has also had intermittent episodes of associated blurry vision. The patient's visual acuity acutely worsens during periods of reading, driving, and watching television. She reports a past medical history of “seasonal allergies” and takes oral antihistamines without relief of symptoms. Vital signs are within normal limits. Physical examination reveals bilateral conjunctival injection. Visual acuity testing demonstrates 20/80 vision in both eyes bilaterally. Slit-lamp examination using fluorescein stain reveals “spotty” uptake. Oral examination reveals multiple dental caries and halitosis. Laboratory results are demonstrated below: Laboratory value Result Reference Range Hemoglobin 11.3 g/dL 12-16 g/dL Hematocrit 39% 36-46% Leukocyte count 9,100 /mm3 4,500-11,000/mm3 Platelet count 375,000/mm3 150,000-400,000/mm3 Erythrocyte sedimentation rate 5 mm/h 0-20 mm/h Antinuclear antibodies Negative Negative Rheumatoid factor Negative Negative Anti-dsDNA Negative Negative Anti-Ro/La Negative Negative Which of the following is the most likely etiology of this patient’s clinical condition?

Conjunctivitis is a condition caused by inflammation of the conjunctiva. The conjunctiva is the thin clear membrane that lines the inside of your eyelids, and covers the whites of your eyes. Conjunctivitis can be caused by infection, allergy, or chemical irritation. Symptoms include eye redness, swelling, itching, discharge, and crusting around the eyes.

Conjunctivitis

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Laboratory value	Result	Reference Range
Hemoglobin	11.3 g/dL	12-16 g/dL
Hematocrit	39%	36-46%
Leukocyte count	9,100 /mm3	4,500-11,000/mm3
Platelet count	375,000/mm3	150,000-400,000/mm3
Erythrocyte sedimentation rate	5 mm/h	0-20 mm/h
Antinuclear antibodies	Negative	Negative
Rheumatoid factor	Negative	Negative
Anti-dsDNA	Negative	Negative
Anti-Ro/La	Negative	Negative