MRCP2-1716

MRCP2-1716

A 45-year-old woman presents with eye irritation that has been ongoing for a few weeks. She attributes this to the recent sunny weather and high pollen levels. She has a history of primary biliary cirrhosis and is currently being treated with ursodeoxycholic acid. She wears contact lenses for myopia and changes the washing solution regularly. On examination, both eyes are red with conjunctival injection, but there is no exudate or photophobia. Her visual acuity is 6/6 bilaterally, and the slit lamp exam is normal. Fluorescein staining shows no abrasion. She has a fine tremor, and there are no palpable neck lumps. Laboratory results show elevated bilirubin, ALP, ALT, and γGT levels, as well as low albumin and positive rheumatoid factor. Her TSH level is within normal limits. What is the most likely diagnosis?