Question: Can you identify this condition?

An 11-year-old boy presented with a chronic history of itching and watering eyes, photophobia, and marked redness in both eyes. On examination, visual acuity was 20/20 for both eyes. Slit lamp examination revealed a shield ulcer with a clear base on the right cornea (Figure 1A). The left cornea had a shield ulcer with a similar clinical picture (Figure 1B). Right eyelid eversion revealed papillae under the lid (arrow, Figure 1C). Lid eversion of the left eye showed papillae after staining with 1% sodium fluorescein dye (arrow, Figure 1D). There was no evidence of corneal infiltration and the anterior chamber was quiet in both eyes. The intraocular pressure was 14 mm Hg in each eye. There was no history of systemic allergy, allergic bronchitis, or skin allergy.

The most likely diagnosis is

1. Vernal keratoconjunctivitis with shield ulcers

2. Atopic keratoconjunctivitis

3. Fibrosing conjunctivitis

Answer on page 540

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