Purpose: To report a case of refractory atopic blepharoconjunctivitis (ABC) treated by using topical tacrolimus 0.03% dermatologic ointment. Methods: A 73-year-old man with ABC was refractory to topical corticosteroid treatment. Results: Topical tacrolimus 0.03% dermatologic ointment (Protopic; Astellas Pharma) was applied into the conjunctival fornix twice each day. Dramatic improvement of patient's symptoms was observed during the first week of therapy. Tacrolimus ointment treatment continued for 12 months. No drug-induced conjunctival hyperemia, ocular surface staining, or other adverse changes were noted secondary to the use of the topical tacrolimus ointment. Conclusions: Topical tacrolimus 0.03% dermatologic ointment appears to be an effective treatment for ABC that is refractory to conventional therapy.