Conjunctival hyperemia and discharge are found in the majority of patients on clinical examination. Specific signs include Horner-Tranta’s dots, shield ulcers and cobblestone appearance in VKC, sandpaper like eyelid texture in AKC, and giant conjunctival papillae in GPC.

• Mild to moderate conjunctival injection
• Conjunctival chemosis, more than expected for a particular degree of redness

• ‘Cobblestone-like’ giant papillae on flipping the upper tarsal conjunctiva, sometimes with a tenacious mucous discharge^[2]
• Central Punctate epithelial keratitis (keratitis epithelialis vernalis of El Tobgy). The dots may coalesce to form a whitish or grayish plaque beneath the epithelium which interfere with vision and lead to central corneal scarring.
• Tranta’s dots: Clumps of necrotic eosinophils, neutrophils, and epithelial cells^[3]. They tend to disappear when symptoms abate^[1].
• Shield ulcers in the superior sectors of the cornea : Noninfectious, oval-shaped, circumscribed epithelial ulcer with underlying stromal opacification^[4]

• Red, elevated, eczematous lesions on the eyelids, or any place on the body.
• Fine sandpaper-like texture of the eyelid skin
• Conjunctival injection and chemosis with giant papillae
• Conjunctival scarring
• Atopic cataracts

• Giant papillae covering the tarsal conjunctiva
• Rest of the clinical findings are similar to VKC without corneal involvement^[6].