Sago grain vs cobblestone appearance in palpebral conjuctiva? How to differentiate

Sago grain vs cobblestone appearance in palpebral conjuctiva? How to differentiate

Hi Pg aspirant, Cobblestone appearance, which is a papillary reaction in the palpebral conjunctiva, and also the presence of ropy discharge points towards the diagnosis of spring catarrh or vernal keratoconjunctivitis (VKC). Sago grains appearance, commonly seen on upper tarsal conjunctiva and fornix. These follicles seen on the bulbar conjunctiva are pathognomonic of trachoma. There is no ropy discharge in trachoma as compared to VKC. Also sago grains are circular in appearance whereas the papillary reaction is more rectangular in shape giving rise to cobblestone appearance.

Thank you.