'Cobble stone' appearance of conjunctiva is seen in
High-Yield Explanation
(A) Spring catarrh > Each papilla is polygonal with a flat fop and contains tufts of capillaries and dense fibrous tissue. The hyaline degeneration imparts bluish-white or milky colour to the papilla.# Vernal keratoconjunctivitis or spring catarrh is a recurrent, bilateral, interstitial self limiting allergic inflammation of conjunctiva having a periodic seasonal incidence:> Vernal conjunctivitis or Spring catarrh;> Predisposing factors: Age: 4-20 years Sex: More in boys than girls Season: More common in summer (Name is a misnomer as it is more common in summer rather than spring)> Agent: is produced in response exogenous allergen (dust, pollen, heat)> Laterality: is bilateral> Presentation: Most marked symptom is itching (Photophobia and lacrimation arc also seen) Ropy discharge : Maxwell Lyon sign (containing eosinophills) Conjunctival SignsBulbarCorneal SignsPalpebralGelatinous thickening around LimbusEpithelial erosionCobble stone appearanceHorner Trantas spots (composed of degenerated eosinophils)Supepethelial punctate erosion and scarringPapillary hypertrophy into polygonal papillaDusky red triangular congestionsPseudogerantoxon with classic cupid bow outlineFollicle are not seen in vernal conjunctivitis Ulcer may be present.