Antihistamine eye drops are first-line treatments for allergic conjunctivitis; however, patient compliance and ocular itch exacerbation during medication intervals remain challenging. This study investigated the clinical application of 0.5% topical epinastine eyelid cream in patients with symptomatic perennial allergic conjunctivitis already using antihistamine eye drops.Fourteen patients with perennial allergic conjunctivitis using antihistamine eye drops were prescribed 0.5% topical epinastine eyelid cream. Patients applied the cream once daily before bedtime. Questionnaires assessed medication compliance, 24-hour ocular itch scores, and daytime quality of life (QOL). Statistical analysis used a mixed-effect model for repeated measures.All 14 patients completed the proactive eyelid cream medication. Ocular itch scores significantly decreased from baseline to the next morning (P = 0.003). Daytime QOL scores showed significant changes between baseline and first and second applications (P < 0.001 for both).A 0.5% topical epinastine eyelid cream demonstrates potential as a convenient, once-daily treatment for allergic conjunctivitis, offering consistent symptom control and improved patients' QOL. Further long-term studies are recommended to validate these initial findings.