Which type would you expect to have the smallest papillae?

• A. VKC
• B. AKC
• C. GPC
• D. EKC

Answer: (B)

Papillary conjunctivitis varies by condition, and the size of the papillae helps distinguish them. Vernal keratoconjunctivitis shows prominent, cobblestone-like giant papillae on the upper eyelid. Giant papillary conjunctivitis also produces large papillae due to chronic irritation from contact lenses. Epidemic keratoconjunctivitis is driven more by follicles in the conjunctiva and doesn’t rely on large papillae as a defining feature, though small papillae can be present. Atopic keratoconjunctivitis tends to have a thickened, edematous conjunctiva with a less dramatic papillary reaction, so the papillae are comparatively smaller.

Hence, the smallest papillae would be expected in atopic keratoconjunctivitis.