Ocular surface disease could partly account for his asthenopia and photophobia. Chronic eyestrain can result in conjunctival hyperemia and a chronic blepharoconjunctivitis, although it is not seen commonly today.16 Perhaps it was a chronic follicular conjunctivitis, which has a variety of origins, including chlamydia, although Pepys never mentions a mucus discharge. Did the noxious irritants within the candle and chandelier smoke aggravate his ocular surface? Does the Cavalier medallion suggest low-grade thyroid eye disease with prominent eyes, lid retraction, and eyelid edema, resulting in secondary lagophthalmos, corneal exposure, tear film disruption, and dry eye? Perhaps the gunshot injury in 1660 resulted in a more significant burn or injury than previously thought, and this resulted in chronic ocular surface problems, dryness, or even recurrent corneal erosion syndrome. Similarly, in 1677 Pepys actually attributes his eye problems to a trip to the glasshouse and gazing much on the flame within the furnace. A number of other external eye diseases could be considered. Lastly, migraine, one of the most common causes of photophobia in the general population, must be in the differential diagnosis.