A 7year old boy presented with recurrent bilateral conjunctivitis occuring in hot weathers with symptoms of burning, itching, and lacrimation. On examination, there are large flat topped papillae in the palpebral conjunctiva. The diagnosis is:
Answer: D. Vernal Keratoconjunctivitis
Explanation: Patients with VKC generally present in early to mid-childhood. Symptoms consist predominantly of eye itching, along with tearing, discharge, irritation, redness, blepharospasm, and photophobia.
Clinically, VKC can be divided into 3 subtypes: conjunctival, limbal, and mixed presentations
On external examination, the lids can be erythematous and thickened; a reactive ptosis may be present due to photosensitivity
The classic finding of giant papillae (> 1 mm diameter) is located most commonly on the upper tarsal conjunctiva.
The tarsal conjunctiva develops a cobblestone appearance and, in active disease, can have mucus accumulation between the papillae. In the limbal form, the conjunctiva may show a fine papillary reaction. Here the predominant findings are gelatinous limbal papillae associated with epithelial infilt++rates called Horner-Trantas dots. These are focal collections of degenerated eosinophils and epithelial cells.