Which finding is NOT typically associated with AKC?

• A. Dennie's lines
• B. Small inferior papillae
• C. Shield ulcer formation
• D. Bilateral itching of the eyelids

Answer: (C)

In atopic keratoconjunctivitis, the allergic inflammation tends to produce lid and conjunctival surface changes, and you’ll usually see signs like Dennie-Morgans lines—folds under the lower lids from chronic edema—and a papillary reaction with small inferior papillae on the tarsal conjunctiva. Patients are typically bilaterally itchy, which is a common symptom of ocular surface allergy.

Shield ulcers, on the other hand, are a corneal complication most classically associated with vernal keratoconjunctivitis. They are a shield-shaped epithelial defect on the cornea that arises from chronic rubbing and eosinophilic inflammatory damage, and they’re not typically seen in AKC. So the finding that does not fit AKC is shield ulcer formation.