Vernal Keratoconjunctivitis

An 8-year-old boy from rural Maharashtra presents with intense itching and foreign body sensation in both eyes for the past 3 months, worse during summer. His mother reports he rubs his eyes constantly. On examination, the conjunctiva shows large papillae on the upper tarsal surface, and a gelatinous thickening is noted at the limbus with Horner–Trantas dots. Vision is 6/9 in both eyes. What is the most appropriate first-line topical treatment?

A 10-year-old girl from Tamil Nadu presents with recurrent episodes of eye pain, photophobia, and blurred vision during summer months over the past 2 years. Slit-lamp examination reveals a shield ulcer on the central cornea with overlying mucus. The conjunctiva shows giant papillae on the upper tarsal surface. What is the most likely mechanism of corneal damage in this condition?

Which histological finding is pathognomonic for vernal keratoconjunctivitis?

A 9-year-old boy from rural Maharashtra presents with intense itching and foreign body sensation in both eyes for the past 3 months, worse in spring and summer. On examination, he has bilateral conjunctival injection, thick ropy mucoid discharge, and giant papillae (>1 mm) on the upper tarsal conjunctiva. Vision is 6/9 in both eyes. He denies any systemic symptoms or recent travel. What is the most likely diagnosis?

Which mediator is primarily responsible for the eosinophil recruitment and degranulation in vernal keratoconjunctivitis?