Which finding is NOT typically associated with VKC?

• A. History of asthma
• B. 20 year old patient with history of atopic dermatitis
• C. Cobblestone papillae superiorly
• D. 8 year old boy

Answer: (B)

VKC is a chronic allergic conjunctivitis that typically begins in childhood, often in boys, and is commonly linked with other atopic conditions like asthma and atopic dermatitis. The most characteristic ocular signs include big, cobblestone-like papillae on the upper tarsal conjunctiva.

In this scenario, the finding that is not typical is a 20-year-old with a history of atopic dermatitis. While atopy can be present, VKC usually presents earlier in life, and an onset in early adulthood is unlikely. The other clues fit the usual VKC pattern: asthma history often accompanies atopy, cobblestone papillae on the upper tarsus is a classic sign, and an 8-year-old boy is a common age group for VKC.