A 10-year-old boy presents with recurrent bilateral intense itching, photophobia, and a ropy discharge. Slit-lamp examination reveals giant papillae (cobblestone appearance) on the upper tarsal conjunctiva bilaterally and Horner-Trantas dots at the limbus. The diagnosis is:

• A Vernal keratoconjunctivitis (VKC) ✓
• B Atopic keratoconjunctivitis (AKC)
• C Trachoma — active stage (TF-TI)
• D Giant papillary conjunctivitis (GPC) from contact lens wear

Explanation

Vernal keratoconjunctivitis (VKC) is a bilateral, recurrent, seasonal, IgE-mediated allergic conjunctivitis occurring predominantly in young boys in warm climates. Giant cobblestone papillae on the upper tarsal conjunctiva and Horner-Trantas dots (eosinophil and epithelial cell accumulations at the limbus) are pathognomonic. Ropy (stringy) mucus discharge is characteristic. AKC occurs in adults with severe atopic dermatitis and may cause scarring. Trachoma (Chlamydia trachomatis) causes follicles (not giant papillae) on the upper tarsal conjunctiva, and Lister's follicles at the limbus evolve into Herbert's pits — not Trantas dots. GPC is associated with foreign body (contact lens) exposure and lacks limbal Trantas dots.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.