A 3-year-old girl with eye pain.

A 3-year-old girl presents with bilateral eye pain. The history of the complaint began 3 weeks earlier with headache, photophobia, and intermittent eye pain. During this time, no erythema or discharge from the eyes is noted and no other symptoms reported. Her medical history is positive for multiple parental-diagnosed allergies and chemical sensitivities, resulting in behavioral problems, frequent loose stools, and abdominal pain. Her parents express concern that she may have gastroesophogeal reflux disease and irritable bowel syndrome. Examination reveals an alert but irritable 3-year-old girl with normal vital signs. Her development is delayed and behavior is abnormal, with extreme fear and anxiety. Abnormal findings related to her eyes include dry, lusterless corneas, visible ulcerations, and a large area of hyperkeratosis with some erythema of the right eye. She also has rough, dry skin. Under anesthesia, an ophthalmologic examination determines that the corneal ulcer in the right eye requires an emergent corneal transplant.