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An 11-year-old female presents with the complaint of a foreign body sensation in both eyes for about one month. She has been using antihistamine and steroid drops. The appearance of her lower tarsal conjunctiva is as shown in the pictures above. Her vision is 6/6 in both eyes. Careful evaluation of the lower tarsus reveals multiple avascular, oval, pale elevations, some as large as 2 mm.

1.	The tarsal lesions are most likely to be:
	b -- follicles These lesions are most likely follicles. Follicles are described as avascular oval elevations 0.2 to 2 mm in diameter that are flesh colored and partially translucent. Blood vessels never travel up the center of the structure. A follicle is a lymphocytic response. Drusen are seen in the optic nerve and hordeola are infections of the lash follicles (external) or meibomian glands (internal).
2.	The most important differential feature in determining the identity of these structures on the tarsus is:
	c -- lack of central vascular core The key to the differential between a papilla and a follicle is that the papilla has a central vascular core and the follicle does not; although small vessels may sweep over the top of a follicle.
3.	These tarsal lesions can be seen in:
	e -- all of the above Causes of acute follicular conjunctivitis lasting three weeks or less: Adenovirus Herpes simplex Enterovirus 70 Coxsackie A24 Causes of chronic follicular conjunctivitis: Chlamydia trachoma Inclusion conjunctivitis Chlamydia zoonose Molluscum contagiosum Parinaud’s oculoglandular syndrome Moraxella Hemophilus Streptococcus Staphylococcal blepharitis Lyme conjunctivitis Papillary conjunctivitis is usually due to an allergic response such as seasonal allergic conjunctivitis (hay fever) which is mild, self-limiting and episodic or the more serious and prolonged vernal conjunctivitis that begins between 5 and 10 years of age, usually in males and lasting up to 10 years. Giant papillary conjunctivitis can be seen as a reaction to soft contact lens wear.