A 10-year-old atopic child presents with intense itching, photophobia, and a foreign body sensation worse in summer. Slit-lamp examination reveals giant cobblestone papillae on the upper tarsal conjunctiva and a shield ulcer on the upper cornea. The most appropriate initial management is:
- A Topical acyclovir
- B Systemic doxycycline
- C Topical mast-cell stabilisers and antihistamines ✓
- D Topical antifungal agents
Correct answer: C. Topical mast-cell stabilisers and antihistamines
Explanation
The clinical picture describes vernal keratoconjunctivitis (VKC), a bilateral, recurrent, seasonal allergic condition predominantly affecting young atopic males. Giant papillae on the upper tarsal conjunctiva and shield (Togby) ulcers on the upper cornea are pathognomonic. Mast-cell stabilisers (sodium cromoglicate) combined with topical antihistamines are first-line; short-course topical steroids are added for acute flares.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.