Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K33/00—Medicinal preparations containing inorganic active ingredients
  • A61K33/04—Sulfur, selenium or tellurium; Compounds thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
  • A61K47/36—Polysaccharides; Derivatives thereof, e.g. gums, starch, alginate, dextrin, hyaluronic acid, chitosan, inulin, agar or pectin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0014—Skin, i.e. galenical aspects of topical compositions
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0048—Eye, e.g. artificial tears
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P27/00—Drugs for disorders of the senses
  • A61P27/02—Ophthalmic agents

Definitions

• SeS2 Selenium sulfide
• Dermatitis a condition in which seborrheic dermatitis, tinea versicolor and dandruff. It is typically used as shampoo, foam or lotion at commercially available concentrations of 1% and 2.5% and is applied for several minutes, then rinsed off.
• the use of SeS2 can be associated with known side effects that are listed in the drug insert and which may include irritation, burning, and on rare occasion, loss and discoloration of hair.
• Adverse events reported following topical ocular use of selenium sulfide containing products include: superficial punctate keratitis and conjunctivitis which resolved upon cessation of treatment.
• SeS2 When SeS2 is applied topically for the treatment of tinea versicolor, skin irritation may occur in the genital areas and/or folds of the skin. SeS2 lotions can also cause rebound oiliness of the scalp.
• SeS2 lotion has been reported to cause systemic toxicity following topical application to damaged skin. Following long-term topical use of the lotion in a woman with an open lesion on her scalp, systemic signs and symptoms of toxicity including tremors, severe perspiration, garlicky breath, pain in the lower abdomen, weakness, lethargy, loss of appetite, and occasional vomiting occurred. Signs and symptoms of toxicity resolved within 10 days after discontinuing the drug. Selenium may be toxic when taken by mouth in high doses (> 400 pg per day) or for long durations. Acute selenium poisoning is potentially lethal due to cardiocirculatory failure and/or pulmonary edema. Gastrointestinal effects are generally the first symptoms seen with acute selenium poisoning.
• Acute effects may include: vomiting, hypersalivation, diarrhea, abdominal pain, a burning sensation in the nostrils and/or oral mucosa, chemical bums of the alimentary tract and a garlic-like odor on the breath.
• Poisoning from long-term use is similar to arsenic poisoning, with symptoms including hair loss, white horizontal streaking on fingernails, nail inflammation, fatigue, irritability, nausea, vomiting, garlic breath odor, and a metallic taste.
• Selenium can also cause muscle tenderness, tremor, lightheadedness, facial flushing, blood clotting problems, liver and kidney problems, and other side effects. Acute systemic effects of selenium are not expected in the target patient population with the proposed dosing regimen.
• Non-specific allergic reactions including rash and urticaria, have been reported rarely.
• Selenium compounds have UV protective effects. Specifically, topical selenium compounds increase the minimum dose of UV radiation required to cause skin reddening and protect against skin damage caused by UVB exposure (radiation with a wavelength of about 290 nm to about 320 nm). In some instances, this is because intracellularly selenium's major function is upregulation of the enzyme glutathione peroxidase (GPX) as an antioxidant.
• GPX glutathione peroxidase
• Selsunef ® was used in the clinic in 80 subjects, where gentle and controlled application was performed by a physician who also removed the ointment after 30 min by a swab of cotton wool. Great care was always taken not to introduce any of the ointment into the conjunctival sac. In one case, where the patient administered Selsunef ® to himself, contrary to medical advice, a rather severe keratitis promptly developed.
• MGD meibomian gland dysfunction
• ophthalmic preparations of SeS2 may be applied to the eyelid, eyelid margin, ocular surface, or surrounding tissues. Described herein are the methods of use for an ophthalmic preparation containing SeS2, particularly wherein side effects, such as ocular keratitis are reduced or eliminated.
• administration can be administered by a patient at home (e.g., chronically) (e.g., on a daily basis or less frequently, if appropriate) on the eyelid or over the eyelid margin.
• Adverse effects e.g., pain, local irritation, inflammation, redness, keratosis, etc.
• administration of therapeutically effective concentrations of SeS2 e.g., to the eyelid margin
• reducing exposure to light e.g., UV light
• following administration of the selenium disulfide compositions further reduces the incidents of side effects in ophthalmic applications (e.g., in methods involving administration to the lid margin of an individual).
• the method comprises administering a therapeutically effective amount of a pharmaceutical composition to an ocular surface, surrounding ocular tissues, eyelid, eyelid margin, or a combination thereof of the individual.
• the pharmaceutical composition comprising a therapeutically effective amount of selenium disulfide (SeS2) to the individual, such as to the eyelid margin of the individual in need thereof.
• the individual limits, avoids, or is instructed to limit or avoid (e.g., via oral communication and/or written instruction) exposure to light (e.g., at least to the location to which the composition was administered, to the eye or eyes, or the like) following administration.
• exposure to light e.g., at least to the location to which the composition was administered, to the eye or eyes, or the like
• limiting or avoiding exposure to light following administration of the composition reduces (e.g., the incidences of and/or rate of) keratitis (e.g., relative to administration that does not limit or avoid exposure to light), such as in or around the eye.
• the keratitis is associated with photosensitivity.
• exposure to light is limited or avoided for any suitable time, such as for at least 30 minutes.
• exposure to light is limited or avoided for at least 60 minutes.
• exposure to light is limited or avoided for at least 2 hours.
• increased concentrations and/or amounts of selenium disulfide in the composition result in increased rates of and/or incidences of keratitis or other adverse effect.
• light is avoided for longer periods of time than when compositions with lower concentrations and/or amounts of active are administered.
• the composition is administered to the lid margin of the individual. In certain embodiments, administration of the composition to the ophthalmic surface is avoided. In some embodiments, while light may be avoided following administration, the composition is administered under good-light conditions, such as to avoid unwanted administration of the composition to the surface of the eye.
• the site to which the composition was administered is generally maintained or the individual is instructed to maintain the site to which the composition was administered in low-light conditions.
• the low-light conditions are about 100 lux or less, about 50 lux or less, or about 25 lux or less.
• the site to which the composition was administered is generally not exposed to or the individual is instructed to limit or avoid exposure of the site to which the composition was administered to high light conditions.
• the high-light conditions are about 100 lux or more, about 500 lux or more, or about 1,000 lux or more.
• the specific time of day is about later than about hour before dusk.
• the specific time of day is after dusk (nighttime).
• the specific time of day is before (e.g., within an hour, half-hour, or the like of) bedtime.
• obstruct e.g., direct
• some or all light e.g., sunlight
• obstruction of light is achieved by wearing headwear and/or eyewear that at least partially obstructs light.
• the headwear is a hat.
• the eyewear is sunglasses or goggles.
• the individual self-administers the composition.
• limiting exposure to light comprises limiting exposure to at least some wavelengths of light. In some embodiments, limiting exposure to light comprises limiting exposure to ultraviolet (UV) light. In some embodiments, limiting exposure to light comprises limiting exposure to sunlight. In some embodiments, the individual is instructed to remain indoors. In some embodiments, the individual avoids is instructed to avoid sunlight or ultraviolet (UV) light (e.g., at least where the composition is administered).
• UV ultraviolet
• the disease or disorder in or around the eye is meibomian gland dysfunction (MGD), blepharitis, seborrheic blepharitis, Demodex infestation, dry eye syndrome, hyperkeratosis, dermatitis, keratitis, contact lens discomfort, lid wiper epitheliopathy (LWE), Keratoconjunctivitis Sicca, Sjogren's Syndrome, or ocular rosacea.
• MMD meibomian gland dysfunction
• blepharitis seborrheic blepharitis
• Demodex infestation dry eye syndrome
• hyperkeratosis dermatitis
• keratitis contact lens discomfort
• lid wiper epitheliopathy (LWE) Keratoconjunctivitis Sicca
• Sjogren's Syndrome or ocular rosacea
• the disease or disorder in or around the eye is Blepharitis or Seborrheic Blepharitis.
• the composition comprises SeS2 in a therapeutically effective concentration.
• the therapeutically effective concentration is about 0.1 wt. % to about 10 wt. % (e.g., about 0.1 wt. % to about 10 wt. %, or about 0.5 wt. % to about 1 wt. %).
• the composition is administered in a volume of less than 25 pL.
• the composition is administered in a volume of about 1 pL to about 20 pL (e.g., about 2 pL to about 15 pL, or about 3 pL to about 10 pL).
• the composition or formulation is a semi-solid (e.g., gels, cream, paste), strip, emulsion, suspension, foam, lotion, spray, patch, implant (e.g., slow release, biodegradable, semi-degradable, or non-degradable), lipid base systems (e.g., solid lipid nano/micro particles, liposomes, exosome, micelles, micro/nano emulsions, cubosomes, cochleatses, niosomes, lipospheres), silica based system (e.g., mesoporous), polymer based system, nano and/or micro-spheres, nano- and/or micro-capsules, nano- and/or micro-particles, or the like.
• lipid base systems e.g., solid lipid nano/micro particles, liposomes, exosome, micelles, micro/nano emulsions, cubosomes, cochleatses, niosomes
• the semi-solid is an ointment.
• the composition is administered in a sufficiently low volume, and (ii) following administration, exposure to light of the site to which the composition was administered is sufficiently low, such that keratitis (e.g., of an ocular surface of the individual) is reduced or avoided.
• lower concentration can support more light exposure with minimal risk of phototoxicity.
• the amount of light exposure tolerated and duration to avoid light exposure is correlated to the dose and concentration of SeS2 administered.
• Certain embodiments provided herein are methods for treating a disease or disorder in or around the eye in an individual in need thereof, such process comprising protecting an ocular surface of the individual with a barrier.
• the process further comprises administering a therapeutically effective amount of a pharmaceutical composition to the ocular surface of the individual.
• the pharmaceutical composition comprises a therapeutically effective amount of selenium disulfide (SeS2).
• protecting of the ocular surface of the individual comprises administering an ointment or hyaluronic acid (HA) to the ocular surface (e.g., thereby forming the barrier by interacting hyaluronic acid (HA) with mucin on the ocular surface).
• the hyaluronic acid (HA) has a molecular weight of at least 900 kDa.
• the barrier is a contact lens.
• the protecting the ocular surface comprises administering an additive molecule to the ocular surface (e.g., prior to administration of a pharmaceutical composition and/or concurrently therewith), the additive molecule comprising a molecule configured to capture a free radical or photosensitized SeS2.
• the free radical is a reactive oxygen species (ROS).
• the additive comprises a phenolic compound, vitamin E, vitamin C, carotenes, ferritin, ceruloplasmin, selenium, reduced glutathione (GSH), manganese, ubiquinone, zinc, flavonoids, coenzyme Q , melatonin, bilirubin, taurine, or cysteine.
• the barrier prevents the SeS2 from contacting the ocular surface.
• administering a therapeutically effective amount of pharmaceutical composition to the ocular surface, surrounding ocular tissues, or a combination thereof of the individual comprises applying the pharmaceutical composition with a finger.
• the finger can be a finger of the individual.
• compositions and methods of administering compositions wherein the composition is not a shampoo.
• FIG. 1 illustrates a flowchart depicting mechanisms by which light may interact with a photosensitive chemical to produce phototoxicity in an individual in contact with said photosensitive chemical.
• the terms “individual,” “patient,” or “subject” are used interchangeably. None of the terms require or are limited to situation characterized by the supervision (e.g. constant or intermittent) of a health care worker (e.g. a doctor, a registered nurse, a nurse practitioner, a physician’s assistant, an orderly, or a hospice worker).
• a health care worker e.g. a doctor, a registered nurse, a nurse practitioner, a physician’s assistant, an orderly, or a hospice worker.
• the term “comprise” or variations thereof such as “comprises” or “comprising” are to be read to indicate the inclusion of any recited feature but not the exclusion of any other features.
• the term “comprising” is inclusive and does not exclude additional, unrecited features.
• “comprising” may be replaced with “consisting essentially of’ or “consisting of.”
• the phrase “consisting essentially of’ is used herein to require the specified feature(s) as well as those which do not materially affect the character or function of the claimed disclosure.
• the term “consisting” is used to indicate the presence of the recited feature alone.
• the composition comprises selenium disulfide (SeS?).
• the individual limits, avoids, or is instructed in a manner such as to limit or avoid exposure to light following administration.
• exposure of the treated area to light especially sunlight or other ultraviolet light sources, in order to prevent, reduce, or limit the risk of, the rate of, and/or incidences of a side effect, such as keratitis.
• prevention, reduction or limitation of the side effect of SeS2 is greater and/or more likely when the SeS2 composition has high concentration of SeS2 and/or the SeS2 composition is provided in a high dose.
• the disease or disorder in or around the eye is a disease or condition treated or treatable by a composition, such as described herein.
• the disease or disorder may be one or more conditions selected from the group comprising meibomian gland dysfunction (MGD), blepharitis, seborrheic blepharitis, Demodex infestation, dry eye syndrome, hyperkeratosis, dermatitis, keratitis, contact lens discomfort, lid wiper epitheliopathy (LWE), Keratoconjunctivitis Sicca, Sjogren's Syndrome, or ocular rosacea.
• MGD meibomian gland dysfunction
• blepharitis seborrheic blepharitis
• Demodex infestation dry eye syndrome
• hyperkeratosis dermatitis
• keratitis contact lens discomfort
• lid wiper epitheliopathy LWE
• Keratoconjunctivitis Sicca Sjogren's Syndrome
• ocular rosacea ocular rosacea.
• the disease or disorder in or around the eye is blepharitis. In some embodiments, the disease or disorder in or around the eye is seborrheic blepharitis. In some embodiments, the disease or disorder in or around the eye is blepharitis associated with MGD. In some embodiments, the disease or disorder in or around the eye is dry eye syndrome. In some embodiments, the disease or disorder in or around the eye is a condition characterized by insufficient secretion of lipids.
• light avoided according to any method provided herein is a light that may result in phototoxicity and/or other adverse effect when combined with a therapeutic administration of a composition provided herein in or around the eye.
• all wavelength of light are partially or completely blocked.
• select wavelengths of light are partially or completely blocked.
• the light includes infrared light, visible light, ultraviolet light, certain wavelengths thereof, and/or combination thereof.
• light comprises visible and/or ultraviolet light.
• the light comprises visible light.
• the light comprises ultraviolet light.
• the ultraviolet light comprises both UVA and UVB light.
• light comprises UVA or UVB light.
• light is from the sun (sunlight). In some embodiments, light is not sunlight.
• methods provided herein provide for therapies involving reduced (e.g., incidence or rates) or eliminated photosensitive reaction (e.g., adverse effects resulting from a combination of light and therapeutic administration of a composition provided herein) or photosensitivity (which descriptions are used interchangeably herein).
• adverse effects refer to an adverse physiological response, such as, by way of non-limiting example, keratitis, inflammation, pain, irritation, flaking, redness, discoloration, or any combination thereof.
• such adverse effects refer to a feeling of grittiness, a feeling of a foreign body in the eye of an individual, blurry vision, redness, tired eyes, symptoms of dry eye disorder, stinging, watery eyes, irritation, lid abnormalities, corneal adrasion, keratitis, photophobia, staining, or any combination thereof.
• a photoreactive chemical can cause photosensitivity in an individual in contact with said photoreactive chemical through a direct or indirect mechanism as described in FIG. 1. Photosensitivity comprises phototoxicity and photoallergic effects.
• FIG. 1 illustrates a non-limiting schematic of an exemplary mechanism by which a photoreactive chemical 010 may induce phototoxicity 100 in an individual are illustrated.
• UV radiation 020 or any other sufficiently energetic photon interacts with a photoreactive chemical 010
• said photoreactive chemical 010 is elevated to an excited state 030, such that energy from the photon is imparted upon the photoreactive chemical 010.
• the excited state 030 species can expel energy in the form of fluorescence 025 or can impart energy upon a second molecule as further described by the indirect mode 040 or direct mode 080.
• the indirect mode of phototoxicity 040 is facilitated by oxygen 055, such that the excited state 030 species can impart energy upon oxygen 055 via energy transfer or free radical generation 050.
• Both energy transfer and free radical generation 050 to oxygen 055 generates what is called a reactive oxygen species (ROS), illustrated in FIG. 1 by two common species, singlet oxygen and superoxide 060.
• ROS reactive oxygen species
• An ROS such as 060 is highly reactive and can cause oxidation of a variety of molecules which may include a drug or DNA 070 among others. Following oxidation, the newly transformed molecule 070 can exert physiological effects in an individual in contact with the photoreactive chemical 010.
• the photoreactive chemical 010 enhances the inherently damaging (e.g., oxidizing) properties of UV radiation 020 by catalyzing the formation of ROS 060 at a location in contact with the photoreactive chemical 010.
• UV radiation or other sufficiently energetic photons from interacting with a photoreactive chemical 010 may provide protection from phototoxicity 100 and associated photosensitivity.
• the direct mode of phototoxicity 080 is independent of oxygen.
• the excited state 030 species described herein can interact with (e.g., photobinding of) endogenous molecules 090 including but not limited to small molecules, peptides, proteins, and nucleic acids. Photobinding of endogenous molecules 090 can directly exert phototoxicity 100 in a manner similar to that previously described.
• Means for avoiding light exposure may comprise the following: (1) bedtime application after which the subject stays in bed with no light exposure, (2) daytime application such that the individual stays in a dim or dark environment following treatment, and (3) wearing protective headwear or eyewear to shield the treated area from light (e.g., dark sunglasses or UV protective sunglasses).
• the pharmaceutical composition comprises SeS2 in a therapeutically effective concentration. In some embodiments, the pharmaceutical composition comprises SeS2 in less than a therapeutically effective concentration. In some embodiments, the pharmaceutical composition comprises SeS2 in a homeopathic concentration. In some embodiments, the pharmaceutical composition comprises SeS2 in greater than a therapeutically effective concentration.
• the therapeutically effective concentration is about 0.1 wt. % to about 2.5 wt. % (e.g., about 0.5 wt. % to about 1 wt. %). In some embodiments, the therapeutically effective concentration comprises at least about 0.01 wt. %, about 0.05 wt. %, about 0.1 wt. %, about 0.15 wt. %, about 0.2 wt. %, about 0.25 wt. %, about 0.3 wt. %, about 0.35 wt. %, about 0.4 wt. %, about 0.45 wt. %, about 0.5 wt. %, about 0.55 wt.
• wt. % about 0.6 wt. %, about 0.65 wt. %, about 0.7 wt. %, about 0.75 wt. %, about 0.8 wt. %, about 0.85 wt. %, about 0.9 wt. %, about 0.95 wt. %, about 1.0 wt. %, about 1.25 wt. %, about 1.5 wt. %, about 1.75 wt. %, about 2.0 wt. %, about 2.5 wt. %, about 3.0 wt. %, about 4.0 wt. %, about 4.5 wt. %, about 5.0 wt. %, about 5.5 wt.
• the therapeutically effective concentration comprises at most about 11.0 wt. %, about 10.0 wt.
• wt. % about 9.0 wt. %, , about 8.0 wt. %, about 7.0 wt. %, about 6.0 wt. %, about 5.0 wt. %, about 4.0 wt. %, about 3.0 wt. %, about 2.5 wt. %, about 2.0 wt. %, about 1.75 wt. %, about 1.5 wt. %, about 1.25 wt. %, about 1.0 wt. %, about 0.95 wt. %, about 0.9 wt. %, about 0.85 wt. %, about 0.8 wt. %, about 0.75 wt. %, about 0.70 wt.
• the therapeutically effective concentration comprises about 0.01 wt. % to about 15.0 wt. %, 0.01 wt. % to about 10.0 wt. %, 0.01 wt. % to about 9.0 wt. %, 0.01 wt. % to about 8.0 wt. %, 0.01 wt.
• 0.05 wt. % about 0.01 wt. % to about 0.05 wt. %, about 0.05 wt. % to about 4.0 wt. %, about 0.05 wt. % to about 3.0 wt. %, about 0.05 wt. % to about 2.0 wt. %, about 0.05 wt. % to about 1.5 wt. %, about 0.05 wt. % to about 1.0 wt. %, about 0.05 wt. % to about 0.5 wt. %, about 0.05 wt. % to about 0.1 wt. %, about 0.1 wt. % to about 4.0 wt. %, about 0.1 wt.
• administering results in fewer adverse effects.
• administration or use of lower concentrations of SeS2 results in fewer adverse effects.
• administration or use of lower concentrations of SeS2 results in fewer adverse effects.
• administration or use of lower concentrations of SeS2 results in fewer adverse effects.
• administration or use of lower concentrations of SeS2 results in fewer adverse effects.
• administration or use of lower concentrations of SeS2 results in fewer adverse effects.
• the pharmaceutical composition is administered in a volume of less than 25 pL. In some embodiments, the pharmaceutical composition is administered in a volume of about 1 pL to about 20 pL (e.g., about 2 pL to about 15 pL, or about 3 pL to about 10 pL). In some embodiments, the volume of the pharmaceutical composition or the volume of pharmaceutical composition administered using a method provided herein (e.g.
• the volume is at least about 0.01 microliters (pL), at least about 0.05 pL, at least about 0.1 pL, at least about 0.5 pL, at least about 1 pL, at least about 5 pL, at least about 10 pL, at least about 15 pL, at least about 20 pL, or more.
• the volume is from about 0.01 pL to about 50 pL, about 0.1 pL to about 30 pL, about 0.5 pL to 25 pL, about 1 pL to 25 pL, about 10 pL to 25 pL, or about 2.5 pL to about 10 pL.
• the therapeutically effective amount of SeS2 is at least about 0.1 milligrams (mg), at least about 0.2 mg, at least about 0.3 mg, at least about 0.5 mg, at least about 1 mg, at least about 2 mg, at least about 2.5 mg, or the like.
• the therapeutically effective amount of selenium disulfide (SeS2) is about 25 mg or less, about 15 mg or less, about 10 mg or less, 7.5 mg or less, about 5 mg or less.
• the therapeutically effective amount of SeS2 is about 0.5 mg, about 1 mg, about 2 mg, about 3 mg, about 4 mg, about 5 mg, about 6 mg, about 8 mg, about 10 mg, or the like. In some embodiments, the therapeutically effective amount of SeS2 is about 4 mg.
• the composition is a semi-solid. In some embodiments, the composition is an ointment. In some embodiments the composition is applied using a finger. In some embodiments the composition is applied using a swab.
• the pharmaceutical composition is applied to the ocular surface, surrounding ocular tissues, eyelid, eyelid margin, lid wiper, meibomian gland, mucocutaneous margin, eyelashes, lash line, lash follicle, tarsal glands, palpebral border, medial angle, lacrimal papilla and punctum, dermal or epidermal tissue within 1 cm of the ocular surface, dermal or epidermal tissue within 2 cm of the ocular surface, or any combination thereof.
• the composition is self-administered.
• the composition can be administered via a swab or finger.
• the composition is administered to the individual by a medical practitioners (e.g., a doctor, a nurse, a skilled medical technician, etc.).
• the composition is administered to the individual by another individual or by a machine.
• finger administration is preferred.
• administration of a composition provided herein with a finger, rather than with, e.g., a swab results in improved therapeutic efficacy.
• the composition is administered under good-light condition (e.g., under sunlight, under a light having at least 50 lux or more, at least 100 lux or more, about 500 lux or more, or about 1,000 lux or more.
• limiting or avoiding exposure to light following administration of the composition reduces keratitis associated with photosensitivity, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 80%, at least 90%, compared to or relative to administration that does not limit or avoid exposure to light (e.g., either same individual with or without light exposure, or different individuals having similar conditions with or without light exposure, etc.).
• the duration of limiting or avoiding exposure to light may vary depending on the condition of the individual, dose of the composition, concentration of the SeS2 in the composition, previous treatment history of the individual, etc. In some instances, the exposure to light is limited or avoided for at least 30 minutes, at least 60 minutes, at least 90 minutes, at least 120 minutes, at least 3 hours, at least 6 hours, etc.
• the amount of light that is permitted or prevented (e.g., limited, avoided, or instructed to do so, etc.) after the administration of the composition may also vary depending on the condition of the individual, dose of the composition, concentration of the SeS2 in the composition, previous treatment history of the individual, etc. In some instances, an individual is limited, avoided, or instructed to do limit or avoid any high lights (e.g., about 100 lux or more, about 500 lux or more, or about 1,000 lux or more.). In some instances, an individual is allowed to be exposed or the site to which the composition was administered is exposed or maintained at low-light conditions (e.g., about 100 lux or less, about 50 lux or less, or about 25 lux or less, etc.).
• the site to which the composition was administered is generally maintained or the individual is instructed to maintain the site to which the composition was administered in low-light conditions as described herein.
• the individual maintains the site to which the composition was administered in low- light conditions.
• the individual reads printed instructions to maintain the site to which the composition was administered in low-light conditions.
• the individual is provided printed instructions to maintain the site to which the composition was administered in low-light conditions.
• the individual is provided auditory instructions to maintain the site to which the composition was administered in low-light conditions.
• the individual is provided non-auditory instructions to maintain the site to which the composition was administered in low-light conditions.
• low-light conditions are characterized by the physiological response in an observer of said light conditions.
• low-light conditions are characterized in relation to wavelength, lux (lumens/m 2 ), or the combination thereof.
• low-light conditions are provided by night.
• low-light conditions are provided by obstruction of the sun.
• low-light conditions are provided by being indoors.
• low-light conditions are provided by naturally occurring conditions (e.g., overcast weather).
• low-light conditions are provided by exclusion of specific wavelengths or ranges of wavelengths of light.
• low-light conditions are provided by a darkroom.
• low-light conditions are provided by use of a safelight
• low-light conditions are at most about 1000 lux, about 250 lux, about 100 lux, about 50 lux, about 25 lux, about 10 lux, about 1 lux, about 0.1 lux, about 0.01 lux, about 0.001 lux or less. In some embodiments, low-light conditions are at least about 0.001 lux, about 0.01 lux, about 0.1 lux, about 1 lux, about 10 lux, about 25 lux, about 50 lux, about 100 lux, about 250 lux, about 1000 lux, or more.
• low-light conditions are between about 0.001 to about 1000 lux, about 0.001 to about 250 lux, about 0.001 to about 100 lux, about 0.01 to about 1000 lux, about 0.01 to about 250 lux, about 0.01 to about 100 lux, about 0.1 to about 1000 lux, about 0.1 to about 250 lux, about 0.1 to about 100 lux, about 1 to about 1000 lux, about 1 to about 200 lux, about 1 to about 100 lux, about 10 to about 1000 lux, about 10 to about 200 lux, about 10 to about 100 lux, about 25 to about 1000 lux, about 25 to about 250 lux, about 25 to about 100 lux, about 50 to about 1000 lux, about 50 to about 250 lux, or about 50 to about 100 lux.
• the individual directs or is instructed to direct light following administration and limiting/avoiding lights after administration by at least partially directing or being instructed to direct some or all light (e.g., sunlight) to the site to which the composition was administered.
• some or all light e.g., sunlight
• the specific time of day is later than about an hour before dusk. In some embodiments, the specific time of day is later than about two hours before dusk. In some embodiments, the specific time of day is later than about dusk.
• the specific time of day is later than about an hour after dusk. In some embodiments, the specific time of day is later than about two hours after dusk. In some embodiments, the specific time of day is after dusk (nighttime). In some embodiments, the specific time of day is more than about an hour before bedtime. In some embodiments, the specific time of day is less than about an hour before bedtime. In some embodiments, the specific time of day is less than about 30 minutes before bedtime. In some embodiments, administration is performed at night. In specific embodiments, night time administration is a time after 4:00 PM, after 5:00 PM, after 6:00 PM, or the like.
• obstruction of light is achieved by wearing headwear and/or eyewear that at least partially obstructs light. In some embodiments, obstruction of light is achieved by wearing a headwear and/or an eyewear that entirely obstructs light. In some embodiments, obstruction of light is achieved by wearing a headwear and/or an eyewear that at least partially obstructs specific wavelengths of light. In some embodiments, the light obstructed by a headwear and/or an eyewear is not visible light. In some embodiments, the light obstructed by a headwear and/or an eyewear comprises both visible light as well as other forms of radiation. In some embodiments, obstruction of light is achieved by wearing a headwear and/or an eyewear that at least partially obstructs ultraviolet radiation, visible light, infrared radiation, x-rays, and/or gamma rays.
• the headwear is a hat. In some embodiments, the headwear is a hat with a bill or a brim. In some embodiments, the headwear is a hat without a bill or a brim.
• the eyewear is sunglasses or goggles. In some embodiments, the eyewear is a contact lens. In some embodiments, the eyewear comprises one or more lens. In some embodiments, the eyewear comprises one or more polarized lens. In some embodiments, the eyewear comprises one or more reflective lens. In some embodiments, the eyewear comprises one or more shaded lens. In some embodiments, the eyewear is blindfold.
• the eyewear comprises natural or synthetic fibers or a combination thereof. In some embodiments, the eyewear comprises a reflective surface. In some embodiments, the eyewear comprises a lens or mirror. In some embodiments, the eyewear comprises fabric, a polymer, a plastic, a metal, a non- metal, plant material, plant-derived material, synthetic material, or any combination thereof. [0063] In some embodiments, reduced or avoidance of keratitis is achieved by combining two conditions: i) administering the composition in a sufficiently low volume (even with high concentration), and ii) following administration, exposure to light of the site to which the composition was administered is sufficiently low. In some instances, a lower concentration of SeS2 can support more light exposure with minimal or reduced risk of phototoxicity. In some embodiments, the amount of light exposure tolerated and duration to avoid light exposure is at least partially correlated to the dose and/or concentration of SeS2 composition administered.
• the adverse effect of SeS2 interacting with light is prevented or reduced by protecting the ocular surface of an individual with a barrier.
• the process further comprises administering a therapeutically effective amount of a pharmaceutical composition to the ocular surface of the individual of the individual.
• the pharmaceutical composition comprises a therapeutically effective amount of selenium disulfide (SeS2).
• the ocular surface is protected with a barrier prior to administering the pharmaceutical composition to the ocular surface.
• the ocular surface is protected with a barrier concurrently with the process of administering the pharmaceutical composition to the ocular surface.
• the barrier can be any physical or chemical barrier that is pre-formed before applying to the ocular surface.
• the barrier is formed on the ocular surface after being applied to the ocular surface.
• protecting of the ocular surface of the individual comprises administering an ointment, a polyvinyl alcohol (PVA) microemulsion, other micro or nano emulsions of polymers, or liquid crystal form of polymers that can act as a barrier.
• protecting of the ocular surface of the individual comprises administering lipid or sugar based compound that can cover ocular surface or cornea.
• lipid or sugar based compound includes cross linked dextran or dense liposome.
• protecting of the ocular surface of the individual comprises administering a hyaluronic acid (HA), or any suitable HA-containing compound, which interacts with mucin on the ocular surface and/or the surrounding ocular tissues of the individual and forms a barrier.
• HA hyaluronic acid
• such formed barrier prevents the photosensitized SeS2 from contacting the ocular surface of an individual.
• preferred hyaluronic acid or hyaluronic acid polymer includes those with a molecular weight of at least 700 kDa, at least 800 kDa, at least 900 kDa, at least 1000 kDa, at least 1100 kDa, at least 1200 kDa, at least 1300 kDa, at least 1400 kDa, at least 1500 kDa, at least 2000 kDa, at least 2500 kDa, at least 3000 kDa, or at least 3500 kDa, or between 700-3500 kDa, 700-3000 kDa, 700-2500 kDa, 700-2000 kDa, 700-1500 kDa, 700-1300 kDa, or 700-1200 kDa.
• the protecting the ocular surface comprises administering an additive molecule to the ocular surface as a barrier.
• the additive molecule is configured to, suitable for, or capable of, capture a free radical or photosensitized SeS2, so that the captured free radical or photosensitized SeS2 does not reach, does not directly contact , thereby the adverse effect on the ocular surface is reduced.
• the additive molecule when applied to the ocular surface, capture at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70% of the free radical or photosensitized SeS2.
• the additive molecule comprises one or more of a phenolic compound, vitamin E, vitamin C, carotenes, ferritin, ceruloplasmin, selenium, reduced glutathione (GSH), manganese, ubiquinone, zinc, flavonoids, coenzyme Q , melatonin, bilirubin, taurine, or cysteine.
• the additive molecule is formulated with a suitable excipients (e.g., buffer, etc.) in any suitable form (e.g., gel, hydrogel, ointment, cream, lotion, foam, spray, patch, implant (e.g., slow release, biodegradable, semi-degradable, or non-degradable), lipid base systems (e.g., solid lipid nano/micro particles, liposomes, exosome, micelles, micro/nano emulsions, cubosomes, cochleatses, niosomes, lipospheres), silica based system (e.g., mesoporous), polymer based system, nano and/or micro spheres, nano- and/or micro-capsules, nano- and/or micro-particles, or the like, etc.) to be applied on the ocular surface of the individual before administering the pharmaceutical composition (e.g., SeS2-containing pharmaceutical composition).
• a suitable excipients
• the barrier is a contact lens or any other types of transparent or nontransparent layer that creates a physical barrier on the ocular surface to protect the ocular surface from the photosensitized SeS2 or other reactive oxygen species (i.e., generated from the photoreaction of SeS2).
• the size of the contact lens or any other types of transparent or nontransparent layer varies depending on the area of the protection. For example, the size of the contact lens or any other types of transparent or nontransparent layer is determined to cover at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90% of the ocular surface of the individual.
• Such processes of protecting the ocular surface of the individual from the photosensitized SeS2 or other reactive oxygen species with a barrier enables the SeS2-containing pharmaceutical composition to be administered under a good or high-light condition (e.g., under sunlight, under a light having at least 50 lux or more, at least 100 lux or more, at least 500 lux or more, or at least 1,000 lux or more, etc.) by preventing or reducing the adverse effect of photosensitized SeS2 or phototoxicity from other reactive oxygen species upon administration of the SeS2-containing pharmaceutical composition.
• a good or high-light condition e.g., under sunlight, under a light having at least 50 lux or more, at least 100 lux or more, at least 500 lux or more, or at least 1,000 lux or more, etc.
• such administering step removes or at least reduces the need of further limitation, avoidance or instruction to limit or avoid exposure to light following the administration.
• the patient applied the drug as part of the in-office assessment during the morning hours. About 7 hours later, the patient started to feel significant pain. Upon examination the next morning, the patient showed corneal staining in the form of a band at the interpalpebral fissure and was diagnosed with keratitis. The patient had no adverse events during the first month while applying the drug twice weekly (at home, before bedtime) and had a significant improvement in total ocular surface disease index (OSDI), visual analogue scale (VAS), and standard patient evaluation of eye dryness (SPEED). After resolution of the keratitis this patient continued dosing at bed time with no subsequent development of keratitis.
• OSDI total ocular surface disease index
• VAS visual analogue scale
• SPEED standard patient evaluation of eye dryness
• SeS2 (2.5 wt. %) can produce contact dermatitis, e.g., due to an irritant effect.
• Giordano once applied SeS2 overnight e.g., at night or before bedtime for overnight efficacy
• Robinson and Yaffe used SeS2 cream (1 wt. %) for the same indication twice daily for 2 weeks. The 32 cases described by Robinson and Yaffe indicate that daytime exposure was not a concern, as it was recommended to take a shower only once every 3 days to remove the SeS2 cream.
• dermatitis induced by SeS2 is likely to be photoallergic, as the dermatitis developed five days after the last application.
• the minimum time for the sensitizing processes to be complete is five days.
• phototoxic and primary irritant reactions are seen when the concentration of the photoreactive chemical is high.
• the active compound is non-soluble selenium disulfide with minimal concentrations of soluble selenium ( ⁇ 5 ppm).
• the phototoxicity effect observed in one of the ophthalmic studies described herein are observed at concentrations at least as low as about 0.5 wt.% and 1 wt. %.
• certain concentration levels of SeS2 may tip the balance between protective and sensitizing effects.
• high levels of non-soluble selenium may lead to phototoxicity due to elevated levels of glutathione or other proteins, inducing oxidative imbalance and cellular toxicity. This cellular toxicity and oxidative imbalance may be further elevated by UVA exposure.
• Example 4 An additional 7 subject received 1 wt. % selenium disulfide in a manner similar to that described in Example 2. An additional 2 or 3 additional cases of adverse effects. Of these subjects, 2 had keratitis following the 1 st in-office application and another patient deteriorate following the 2 nd in-office application although the subject kept on another dose or two at home before coming with pain to be examined (a typical scenario when keratitis evolves).
• An additional component of the study requires individuals to apply the ointment in the presence of an ophthalmologist in order to demonstrate proper self-administration technique consistent with the designed study.
• the in-office applications are conducted at specific, pre-determined time points. In these instances, the treatment is not applied before bed but rather is performed during daylight hours.
• Keratitis is not observed in any patients receiving treatment at either the 0.1 wt. % or the 0.5 wt. % concentration. However, four patients note symptoms of keratitis in the 1 wt. % concentration cohort. It should be noted that all four patients describing symptoms of keratitis do so following the prescribed in-office assessment whereas none of the 400 or more bedtime applications of treatment results in keratitis.
• OSDI total ocular surface disease index
• VAS
• At least three other individuals show symptoms of keratitis following a pattern consistent with the first described individual. All four individuals report the initiation of pain between 6 and 20 hours of the in-office assessment, i.e., a 1 wt. % concentration of SeS2 is applied. This pattern of occurrence suggests a correlation between the development of keratitis and both context in which treatment is administered as well as the concentration of treatment administered.
• Determination of time period that treatment is visibly present The duration of time during which the drug product is visibly present on or near the eye of an individual is assessed. Investigators conclude that drug product is no longer visibly present after 5 hours.
• Example 5 An analysis of masked data in two ongoing studies using the same concentration of SeS2 (i.e., 0.5%) at overlapping sites indicates a clear and unexpected tolerability advantage for dosing the drug product only at night.
• SeS2 concentration of SeS2
• the patients were randomized to be administered an SeS2 ointment/semi-solid drug (i.e., 0.1%, 0.5%, or 1.0%) or a placebo for a dosing regimen comprising either a twice-week administration for three months or a once daily dosing for three months.
• an SeS2 ointment/semi-solid drug i.e. 0.1%, 0.5%, or 1.08%
• a placebo for a dosing regimen comprising either a twice-week administration for three months or a once daily dosing for three months.
• Adverse events consist mainly of events associated with tolerability such as burning and stinging after application.
• the rates of ocular adverse events (ocular AE) and more importantly discontinuations from adverse events (DC for AE, that are mostly related to ocular tolerability) appear to be reduced by at least 50% when allowing dosing only in the evening rather than the AM.
• MGS Meibomian Gland Score

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