A 5-year-old boy from a rural area has photophobia and intense itching in both eyes. Slit-lamp examination reveals giant cobblestone papillae on the upper tarsal conjunctiva, limbal Horner-Trantas dots, and shield ulcer on the superior cornea. The diagnosis is vernal keratoconjunctivitis (VKC). The limbal Trantas dots represent:

• A Deposition of IgE immune complexes in the limbal Bowman's zone
• B Limbal stem cell loss from chronic inflammation
• C Goblet cell hyperplasia responding to allergen exposure
• D Activated eosinophil and epithelial cell aggregates at the limbus ✓

Explanation

Horner-Trantas dots are discrete white gelatinous nodules at the corneoscleral limbus in vernal keratoconjunctivitis, representing accumulations of degenerated eosinophils and epithelial cells overlying areas of limbal inflammation. They are pathognomonic of the limbal form (or mixed form) of VKC. Their presence indicates active eosinophil-driven limbal inflammation. IgE complexes are not deposited as visible nodules; stem cell loss causes limbal stem cell deficiency, not discrete dots; goblet cells are in conjunctival epithelium.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.