Conjunctival papillomatous hyperplasia is most often seen in conjunctivitis. Conjunctivitis is a collective term for the inflammatory response of the conjunctival tissues in response to external and the body’s own factors. Although conjunctivitis itself does not usually have a serious impact on vision, when its inflammation spreads to the cornea or causes complications, it can lead to vision impairment. So, how is the differential diagnosis of conjunctival papillomegaly made? The following is the differential diagnosis of conjunctival papillomatosis: Conjunctivitis: the condition is usually mild, but once it develops, it is treated immediately to avoid complications. The physician will take a history, symptoms and treatment medications, and perform a slit lamp microscopy. Chronic conjunctivitis: is a chronic inflammatory disease of the eye in which allergies and environmental factors are the cause and can last for weeks or months. Acute conjunctivitis: Mostly caused by bacteria and viruses, the onset of the disease is more acute and the duration of the disease is short. Conjunctival papillary hyperplasia: Examination reveals redness and swelling of the eyelids, lid conjunctival congestion, papillary follicular hyperplasia, peripheral congestion of the bulbar conjunctiva, sometimes edema and subconjunctival hemorrhage, and secretions in the conjunctival sac. Bacterial and cytologic examination with a smear of the secretion is required to determine the source of the disease. Spring conjunctivitis: Conjunctivitis in spring is called spring conjunctivitis, and its etiology is not well understood. Most scholars believe that it is an allergic eye disease that occurs mostly in children and adolescents with endocrine and vagal instability. It is mostly caused by exposure to grass, pollen, the smell of various grasses and trees, spring air, warm light, the smell of certain animal fur, and in some cases, the ingestion of newly born wild vegetables in spring. These act as antigens and form type I allergic inflammatory disease in the eyes and body. The disease is strongly seasonal, i.e., it develops in the spring, mainly in children and adolescents, with a ratio of 3:1 between men and women, and more people within 20 years of age. It continues to worsen in the summer, slowly remits in the fall, and fades on its own in the early winter after the flowers have faded; it recurs the following year when the flowers bloom, repeatedly for many years. The disease is characterized by unbearable itching of the eyes, photophobia and tearing, and a sense of abrasion. There are three clinical types: lid conjunctival, corneal margin, and mixed, depending on the location of the lesion. The main lesions are: a layer of pavement-like ovoid stone papillae on the lid conjunctiva that is hyperplastic and congested, and nodular hyperplasia of grayish-yellow gelatinous tissue at the corneal limbus. There is a large number of eosinophils in the conjunctival smear and an increased level of IgE in the serum and tear fluid.