Cobblestone papillae are most characteristic of which condition?

• A. Giant Papillary Conjunctivitis
• B. Bacterial Conjunctivitis
• C. Atopic Keratoconjunctivitis
• D. Vernal Keratoconjunctivitis

Answer: (D)

Cobblestone papillae are a hallmark of Vernal keratoconjunctivitis, reflecting a chronic allergic reaction on the upper palpebral conjunctiva. They appear as large, raised papillae across the upper lid, giving a cobblestone-like surface. This characteristic is most often seen in children with seasonal itching and redness, and may be accompanied by limbal changes such as Horner–Trantas dots. While giant papillary conjunctivitis from contact lens wear can also show papillary hypertrophy, the cobblestone pattern is classically linked to VKC. Bacterial conjunctivitis typically presents with mucopurulent discharge rather than this distinctive palpebral look, and atopic keratoconjunctivitis tends to involve more severe surface disease and corneal findings rather than the cobblestone papillae pattern.