Purpose:
Atopic keratoconjunctivitis (AKC) is the least common subtype of allergic conjunctivitis but also the most severe. It is caused by a frequent chronic skin condition called atopic dermatitis, which is seen as eczematous lesions. The diagnosis is made from the clinical presentation of the eyes in patients suffering from the co-morbid atopic disease. On the other hand, Dry Eye Disease (DED) is the most common ocular surface disease. The diagnosis of DED is determined with the presence of symptoms, measured with validated questionnaires, and at least one homeostatic sign, such as a hyperosmolarity of the tear film, tear film instability or compromised integrity of the ocular surface. DED can often be masked by other conditions as the ocular signs are subtle in the mild to moderate form. The aim of their therapies is to improve the symptoms, reduce the periods of exacerbations and avoid complications. Ectoine-containing eyedrops, in conjunction with therapies for Meibomian gland dysfunction, have the potential to stabilize the lipid layer of the tear film and improve the condition of the patient.

Case Report:
A 31-year-old Asian man was referred for an extensive dry eye evaluation from a corneal specialist. He was diagnosed ten years ago with AKC and more recently, with Meibomian gland dysfunction (MGD). The patient complained of chronic burning sensation and fluctuation of vision in both eyes and had a swollen upper left eyelid for the past few weeks. The patient reported having taken different artificial tears, oral and topic antihistamine, and corticosteroid eyedrops over the years but none of them provided an extended relief. This case report shows that ectoine-containing eyedrops, in conjunction with therapies for Meibomian gland dysfunction, increased Meibomian gland expression, reduced palpebral conjunctival hyperemia by up to 50% and improved the major symptoms of the patient.

Conclusion:
The diagnosis of DED can be overshadowed and delayed by the management of other ocular surface diseases, such as AKC, as demonstrated in this case report. Ectoine-containing eyedrops can be a valuable adjunctive therapy which has the potential to stabilize the lipid layer of the tear film. This case report shows that both DED and AKC can benefit from this management. Eyecare practitioners should consider DED as a concomitant condition in many ocular surface diseases as its management can impact positively patient outcomes.