Come in different sizes. Can you bend your principles enough to say that it was nice to run into them and you hope things are well?

True.
I was recently at a social gathering where I had to interact with someone who was one of those nicey-nice, passive aggressive types- Like a knife dipped in honey!
As I was leaving , they gave me a big, cheesy "It was SUCH a PLEASURE to meet you!", expecting me to say the same in return.
I responded with " Well, the pleasure was all YOURS, then..."

My partner gave me shit all the way home.
Apparently, having good "social skills" means being diplomatic, phoney and insincere.

Unless they're coughing up blood in front of you, it wouldn't kill you to tell them "....And you seem like you're in good health".

The proper response is "thanks ". And maybe add "you have the best eyes....sight".

Just say thanks so much and return the compliment with a question like how have you been?

As Goethe once said "A man's manners are a mirror in which he shows his portrait." People in Vancouver could use more manners in daily interactions- it actually makes things easier and more pleasant. If someone says that to me I'll say " You too "- it's short and succinct- and NOT phony.