A sore red eye with systemic involvement.

A 20 year old man was referred to the eye clinic by his general practitioner with a four week history of a sore red left eye (fig 1). Treatment for conjunctivitis had not resulted in improvement, and he reported that his eye was increasingly painful. He had experienced repeated nose bleeds over the past three months, together with constant left sided nasal stuffiness. He had recently felt generally unwell and had lost 4 kg. On examination, his visual acuity was 6/9 in both eyes. His vital signs were stable, but urinalysis showed blood+++ and protein+.