<prompt> 10 yr old male patient came to OPD with itching and cobblestone papillae on examination. The symptoms aggravate in the summer. What is probable diagnosisPhlyctenular conjunctivitisTrachomaAtopic conjunctivitisVernal Keratoconjunctivitis  <response>: 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 Aw 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. 