Viral Meningitis: This condition is characterized by inflammation of the meninges (the protective membranes covering the brain and spinal cord) due to a viral infection. Symptoms include photophobia, headache, fever, and sometimes ocular pain with eye movement. The normal neurological and eye exams do not rule out viral meningitis, as these exams can be normal in early stages or mild cases.

Conjunctivitis: Although the eye exam is normal, conjunctivitis (especially if caused by a virus) could lead to photophobia and discomfort. However, significant ocular pain with eye movement is less typical.
Sinusitis: Sinus infections can cause pain that worsens with eye movement due to the proximity of the sinuses to the eyes. Photophobia and fever can also be present, especially if there's an associated headache.
Optic Neuritis: This is an inflammation of the optic nerve and can cause severe eye pain that worsens with eye movement, along with photophobia. However, a normal eye exam might not immediately suggest this diagnosis unless specific tests for optic neuritis are performed.

Bacterial Meningitis: Although less common than viral meningitis, bacterial meningitis is a medical emergency that requires prompt treatment. It presents similarly to viral meningitis but tends to be more severe and can lead to serious complications or death if not treated immediately.
Encephalitis: Inflammation of the brain tissue, usually due to a viral infection, can cause symptoms similar to meningitis, including photophobia, fever, and severe headache. A normal neurological exam does not rule out encephalitis, especially in early stages.
Subarachnoid Hemorrhage: Although typically associated with a severe headache and possibly altered mental status, a subarachnoid hemorrhage can sometimes present with photophobia and less pronounced neurological deficits initially.

Idiopathic Intracranial Hypertension (IIH): Also known as pseudotumor cerebri, IIH can cause headache, photophobia, and transient visual obscurations. However, it is less commonly associated with fever and ocular pain with eye movement.
Ocular Migraine: Some types of migraines can cause photophobia and are occasionally accompanied by fever. However, the presence of fever and the specific characteristic of ocular pain with eye movement are less typical for migraines.
Sarcoidosis: A systemic disease that can affect various parts of the body, including the eyes and nervous system, causing a wide range of symptoms including photophobia and ocular pain. However, it would be an uncommon initial presentation.