A 5-year-old child presents with itching, photophobia, mucoid discharge, and 'cobblestone' papillae on the upper tarsal conjunctiva. There are also gelatinous Trantas dots at the limbus. Corneal complications include shield ulcer. This presentation is consistent with which form of allergic conjunctivitis, and the key difference from atopic keratoconjunctivitis (AKC)?

• A Vernal keratoconjunctivitis (VKC); AKC occurs in adults with atopic dermatitis, more severe corneal involvement, and year-round symptoms ✓
• B Giant papillary conjunctivitis (GPC); AKC is associated with contact lens wear
• C Seasonal allergic conjunctivitis; AKC has year-round symptoms with no tarsal involvement
• D VKC; AKC has larger papillae and more lacrimal gland involvement

Explanation

Vernal keratoconjunctivitis (VKC) classically affects young males in tropical/warm climates, is seasonal (worsens in spring/summer), and presents with: giant cobblestone papillae on upper tarsal conjunctiva (tarsal type), limbal Trantas dots (limbal type), and horner-trantas papillae. Shield ulcer is the most serious complication. AKC occurs in older patients (15-60 years) with atopic dermatitis, involves all four lid margins and lower tarsal conjunctiva, is perennial, more frequently progresses to corneal scarring/vascularization, and is more sight-threatening. Both have IgE/eosinophilic mechanisms.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.