10 yr old male patient came to OPD with itching and cobblestone papillae on examination. The symptoms aggravate in the summer. What is probable diagnosis: (A) Phlyctenular conjunctivitis, (B) Trachoma, (C) Atopic conjunctivitis, (D) Vernal Keratoconjunctivitis
Answer is D. Vernal keratoconjunctivitis Young boys in 1st decade of life severe itching present cobble stone papillae seen: hallmark. It is a papillary hyperophy not follicular. VKC is type 1 hypersensitivity. Phlyctenular type 4. Signs: Shield ulcer Maxwell lyon sign Horner trantas spots Pseudogerontoxon A/w keratoconus is seen Rx Steroids-Fluorometholone & loteprednol topical. Antibiotics does not have any prominent role. DOC- Olopatadine, Sodium Cromoglycate, Ketotifen and Epinastine. Refractony -Cyclosporine,Tacrolimus & acetyl cysteine 0.5%. Horner Tranta spots Cobblestone pappila Others options: TRACHOMA: commonest infective cause of blindness. hallmark : sago grain follicles. herbet pits seen.