Hard, flat papillae of the lid conjunctiva are a clinical manifestation of springtime khat conjunctivitis disease, which begins with intense lid conjunctival congestion followed by the development of many hard, flat papillae of varying sizes on the upper lid conjunctiva, resembling paved pebbles. The fissure between the papillae is light blue, and the surface of the papillae appears cloudy like cow’s milk. The secretions are small, sticky, and filamentous, and on smear examination, an increase in eosinophils is seen. If the lower lid conjunctiva is diseased, the papillae are small and few, and less prominent than those of the upper lid conjunctiva. Vernal conjunctivitis is an allergic disease that is highly seasonal and often affects both eyes. It develops in spring and disappears in late autumn when it is cold. The disease recurs every year, and in mild cases it does not recur after 3 to 4 years, while in severe cases it can recur continuously for more than 10 years. The disease is characterized by itchy eyes, large, flattened papillae on the lid conjunctiva and conjunctival gelatinous hyperplasia near the corneal limbus, and secretions with large numbers of eosinophils. The cause of the disease may be a metamorphic reaction to free pollen or other substances in the air. The disease is mostly seen in children and young adults, more often in males, and is not contagious. When the local inflammation or virus or foreign body stimulation will lead to local congestion and edema, while not pay attention to good treatment and protection will aggravate the situation, resulting in infection and hyperplasia.