Ans. is 'b' i.e., Spring catarrh Vernal kerato conjunctivitis (spring cattarrh) Spring cattarrh is an allergic inflammation of conjunctiva which is characterized by recurrent, bilateral, interstitial, selflimiting conjunctivitis that becomes aggravated during spring and summer period. It is considered to be Type I hypersensitivity reaction (immediate type) to exogenous allergens such as grass pollens. It is more common in boys and affects age group 4-20 years. More common in summer, hence the name spring catarrh looks a misnomer. Recently it is being labeled as "Warm weather conjunctivitis". Clinical features of spring catarrh Spring catarrh is characterized by marked itching& burning, Stringy (ropy) discharge, lacrimation, photophobia and heaviness of lids. Clinically spring catarrh is divided into three types : ? Palpebral form : - It is the most common types. The upper palpebral conjunctiva shows papillae (papillary hyperophy with their characteristic appearance : - i) Lage & flat toped Cobble stone appearance (Pavement stone appearance). These papilla heal without scarring. Bulbar form : - It is characterized by Dusky red triangular congestion of bulbar conjunctiva in palpebral area; Gelatinous thickened accumulation of tissue around the limbus; Presence of discrete whitish raised dots along the limbus (Tranta's spot). Mixed form : - Both bulbar and palpebral manifestations occur together. Corneal signs (Vernal keratopathy) Punctate epithelial keratitis Ulcerative vernal keratitis : shallow transverse ulcer (Shield ulcer) Vernal corneal plaques Subepithelial scarring Pseudogerontoxon: chracterized by a classical "cupid's bow" outline.