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Allergic conjunctivitis (AC) is common condition in children caused by an acute conjunctival reaction to an environmental allergen presenting with itching, watering, foreign body sensation, papillary congestion, and corneal involvement. Dry eye disease (DED) is a multi-factorial ocular surface disease characterised by loss of tear-film homeostasis, in which ocular inflammation and damage and neurosensory abnormalities play etiological roles.[1] Traditionally, these two are regarded as different diseases, but dry eye remains an under-diagnosed complication of paediatric AC patients. [2-5] Allergic conjunctivitis (AC) and dry eye disease (DED) are highly variable ocular surface inflammatory disorders. These disorders have been regarded to be the epidemics of the 21st century affecting the quality of life. [3] Although patients with AC have mild signs and symptoms, this may have an impact on academic performances and everyday tasks, resulting in poor overall quality of life. The signs and symptoms of AC often overlap with DED, and at times, it becomes difficult to distinguish between the two. In the paediatric population, dry eye is diagnosed much less frequently in general practice but it should be taken seriously when parents bring their children with sign and symptoms. Children often do not complain of the foreign body sensation and burning associated with dry eyes; thus, the routine clinical tests for dry eye diagnosis are seldom performed. [1,6] Fluorescein tear-film break-up time (TBUT) and Schirmer’s tests are invasive tests for dry eye evaluation and require children’s cooperation. Ocular surface analysis (OSA) and clinical photograph, being non-invasive, may be used as an alternative tool for dry eye evaluation in paediatric patients. There is scarcity of literature on the prevalence and clinical features of dry eyes in children with AC. [1,3,7-9] This study aimsto evaluate dry eyes using clinical tests (fluorescein TBUT and Schirmer’s test) and OSA and to correlate with AC symptom scores and clinical grading. This study also aims to treat paediatric population having allergic conjunctivitis after being diagnosed with dry eye disease with lubricating eye drops (combination of sodium hyaluronate and ectoine), topical antihistaminic eyedrops and with topical steroids based on severity of disease. Ectoine, an extremolyte, is a natural protection molecule found in bacteria which survive under extreme conditions of salinity, drought, irradiation, pH, and temperature [1, 2]. Ectoine forms a protective hydration shield around proteins and other biomolecules [3] that is based on its strong binding capacities to water molecules [4]. This mode of action is known as “preferential exclusion”[5]; i.e., ectoine is preferentially excluded from the hydrate shield, leading to the alteration of the aqueous solvent structure [6, 7]. That effect protects proteins from damage and irreversible denaturation and stabilizes biological membranes[4, 8–10]. Thus sodium hyaluronate and ectoine together provides intensive, long lasting lubrication of the ocular surface and protect against the evaporation of tears to relieve itching and burning caused by inflammation and allergies
