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An 11-year-old boy with a background of autism was referred following assessment for bilateral eye pain, watery discharge and erythema. His symptoms had been ongoing for 3 weeks. He described frontal headaches two times a week, occasionally pulsatile with no vomiting. He was noted to have bilateral optic disc swelling with haemorrhages (figure 1) and diffuse punctate staining of both corneas. He had reduced visual acuity (0.675 in the right eye and 0.350 in the left eye). He was commenced on HYLO-Forte drops for dry eyes. Blood pressure was 99/66 mm Hg on arrival (95th centile-for-height was 118/78 mm Hg).