A 6-year-old child presents with fever, mild malaise, and an…

A 6-year-old child presents with fever, mild malaise, and an itchy rash that began on the scalp and spread to the trunk and extremities. On examination, papular and vesicular lesions are seen in different stages of healing. The nurse notes redness and irritation of the eyes. Which of the following findings is most concerning for a potential systemic complication of this disease?