A 62-year-old man with a clinical diagnosis of cGVHD-DE had undergone related-donor bone marrow transplantation for acute myelogenous leukemia in 2011 and experienced irritation and foreign body sensation in both eyes. He was treated with ophthalmic administration including rebamipide ophthalmic suspension four times daily, methylprednisolone containing fradiomycin sulfate (Neo-Medrol  EE Ointment, Pfizer Co., Ltd., Tokyo, Japan) once daily, and betamethasone sodium phosphate containing fradiomycin sulfate (Rinderon -A, Shionogi Pharmaceutical Co., Ltd., Osaka, Japan) 3 times daily. However, his symptoms gradually worsened despite treatment, and he was referred to us. Slit-lamp examination showed SPK with mucous thread and filamentary keratitis (fig. 2). Abnormalities of tear dynamics were shown by Schirmer's test values of 4 mm in the right eye and 10 mm in the left eye, and TBUT of 1 s in the right eye and 1 s in the left eye. The patient's treatment was changed to combined treatment of rebamipide ophthalmic suspension four times daily and fluorometholone ophthalmic suspension once daily. The SH ophthalmic solution was used at any time, if necessary. Subjective symptoms related with cGVHD-DE and corneal epithelial damage improved after change of prescription. DEQS score was restored to 26.7 from 51.2. SPK with mucous thread and filamentary keratitis of his left eye disappeared at 1 month after the combined treatment. SPK with mucous thread and filamentary keratitis of his right eye also disappeared at 3 months after the combined treatment. The condition of both eyes had subsided after 5 months.
 MUC5AC and MUC16 at baseline point showed high-level MUC5AC and low-level MUC16, and they were restored by combined treatment to levels comparable to those in healthy subjects. Considering the relationship between MUC expression on ocular surface including MUC5AC and MUC16 and ocular findings with fluorescein staining, MUC expression showed high levels when SPK with mucous thread and filamentary keratitis persisted, whereas MUC expression levels were restored to the same levels as those in healthy subjects when their clinical findings disappeared.