Vernal keratoconjunctivitis. VKC may be subdivided into 2 varieties, as follows: palpebral and limbal. The classic conjunctival sign in palpebral VKC is the presence of giant papillae. The papillae most commonly occur on the superior tarsal conjunctiva; usually, the inferior tarsal conjunctiva is unaffected. Giant papillae assume a flattop appearance, which often is described as cobblestone papillae.. In severe cases, large papillae may cause mechanical ptosis (drooping eyelid).