Which type would you expect to have the smallest papillae?

Which type would you expect to have the smallest papillae?

• A. VKC
• B. AKC
• C. GPC
• D. EKC

Answer: (B)

Papillary size on the tarsal conjunctiva reflects how pronounced the allergic surface reaction tends to be in a given condition. Vernal keratoconjunctivitis often shows cobblestone-like, giant papillae on the upper lid due to intense chronic irritation. Giant papillae also occur with giant papillary conjunctivitis from contact lens wear. Epidemic keratoconjunctivitis can be severe and gritty with limbal and epithelial involvement, but the papillary reaction is not classically the defining feature and isn’t characterized by giant papillae. Atopic keratoconjunctivitis, while still an allergic condition, tends to have smaller, less prominent papillae on the lid margin and more involvement of the lid skin and limbus. Therefore the smallest papillae are most consistent with atopic keratoconjunctivitis.