HK40035962B - Methods of treating ocular conditions - Google Patents

Description

Methods for treating eye diseases

This application is a divisional application of Chinese patent application No. 201580067940.5, filed on October 19, 2015, entitled "Method for Treating Eye Diseases".

Cross-references

This application claims the benefits of U.S. Provisional Application No. 62/066,280, filed October 20, 2014, and U.S. Provisional Application No. 62/100,844, filed January 7, 2015, both of which are incorporated herein by reference in their entirety.

Background of the Invention

Dry eye disease (“DED”) is a condition affecting millions of people worldwide. In North America, approximately 40 million people suffer from some form of dry eye, and millions more worldwide. DED is caused by the disruption of the natural tear film on the surface of the eye and can lead to eye discomfort, visual impairment, and a decline in vision-related quality of life. Individuals with severe DED are at risk of serious eye health defects such as corneal ulcers and may experience quality of life deficits comparable to moderate to severe angina.

Invention Summary

In some embodiments, a method for increasing tear production is provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors. In some embodiments, a method for increasing tear production comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for increasing tear production comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for increasing tear production comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for increasing tear production is provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for increasing tear production comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for increasing tear production comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for treating dry eye is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors. In some embodiments, a method for treating dry eye comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for treating dry eye comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for treating dry eye comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for treating dry eye is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for treating dry eye comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for treating dry eye comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for improving ocular discomfort is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors. In some embodiments, a method for improving ocular discomfort comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for improving ocular discomfort comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for improving ocular discomfort comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for improving ocular discomfort is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for improving ocular discomfort comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for improving ocular discomfort comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for improving ocular surface health is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for improving ocular surface health comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for improving ocular surface health comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for protecting the ocular surface during challenging environmental conditions is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychiatric side effects. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for increasing mucin content on the ocular surface is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for increasing mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for increasing mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for increasing the mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing the mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In some embodiments, a method for increasing the amount or concentration of one or more tear proteins on the ocular surface is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, the tear protein is epidermal growth factor, lactoferrin, lacrimal protein, prolactin, adrenocorticotropic hormone, leucine enkephalin, ALS2CL, ARHGEF19, KIAA1109, PLXNA1, POLG, WIPI1, ZMIZ2, or other proteins of the tear proteome.

In some embodiments, a method for improving tear clearance is also provided herein, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for improving tear clearance comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a method for improving tear clearance comprises topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount not systemically bioavailable. In some embodiments, a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychiatric side effects. In some embodiments, a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects.

In another embodiment of any of the above embodiments, the method further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In another embodiment of any of the above embodiments, the method further includes the topical application of one or more substances that prevent or reduce the entry of nicotinic acetylcholine receptors into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, the one or more substances are selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase A (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus.

In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, scutellarin, varenclin, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380.

In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033, each of which is incorporated herein by reference.

In another embodiment of any of the above embodiments, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments, at least 500 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity.

In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is administered for at least two days.

In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is administered when needed. In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is administered in response to symptoms when needed. In another embodiment of any of the above embodiments, the timing or frequency of administration of the nicotinic acetylcholine receptor agonist is designed or adjusted to prevent desensitization of the nicotinic acetylcholine receptors.

In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above embodiments, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity via a syringe, dropper, bottle-type nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid injector.

In another embodiment of any of the above embodiments, the trigeminal nerve is activated. In yet another embodiment, the anterior ethmoidal nerve is activated.

In another embodiment of any of the above embodiments, the nasolacrimal reflex is activated.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity is also provided, comprising a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects. In some embodiments, the pharmaceutical formulation further comprises one or more substances selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase A (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, scutellarin, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In some embodiments, the nicotinic acetylcholine receptor agonist is selected from the compounds disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011, or WO2010/028033. In some embodiments, the nicotinic acetylcholine receptor agonist selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. In some embodiments, the pharmaceutical formulation comprises about 1 mg/mL of the nicotinic acetylcholine receptor agonist. In some embodiments, the pharmaceutical formulation comprises about 10 mg/mL of the nicotinic acetylcholine receptor agonist. In some embodiments, the pharmaceutical formulation comprises at least 1 microgram of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 5 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 10 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 25 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 50 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 100 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 250 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises at least 500 micrograms of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation comprises between 5 micrograms and 1 gram of the nicotinic acetylcholine receptor agonist per dose. In some embodiments, the pharmaceutical formulation is administered at least once daily. In some embodiments, the pharmaceutical formulation is administered at least twice daily. In some embodiments, the pharmaceutical formulation is administered for at least two days. In some embodiments, the pharmaceutical formulation is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In some embodiments, the drug formulation is administered into the nasal cavity via a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid injector.

Brief description of the attached diagram

Figure 1 shows a comparison of tear production in patients receiving OC-01 with baseline and placebo.

Figure 2 depicts patient-reported dry eye symptoms in patients receiving OC-01 compared to patients receiving placebo.

Figure 3 shows the Visual Analogue Scale (VAS), which also includes the following description: "There are many symptoms of dry eye, including dryness, stickiness, burning, foreign body sensation, itching, blurred vision, light sensitivity, and pain. Please rate the severity of your current 'dryness' symptoms (not others) by drawing a vertical line on the line below."

Invention Details

Our understanding of the etiology of DED is becoming increasingly clear. DED is inherently progressive and is primarily caused by insufficient tear coverage on the ocular surface. This poor tear coverage hinders healthy gas exchange and nutrient transport on the ocular surface, promotes cell desiccation, and causes poor visual refractive surfaces. Poor tear coverage is typically caused by: 1) insufficient production of aqueous tears by the lacrimal glands (e.g., secondary to postmenopausal hormone deficiency, autoimmune diseases, LASIK surgery, etc.); and/or 2) excessive evaporation of aqueous tears due to meibomian gland dysfunction. Low tear volume creates a high osmotic pressure environment, thereby inducing an inflammatory state on the ocular surface. This inflammatory response induces apoptosis of surface cells, which in turn hinders the proper distribution of the tear film on the ocular surface, making any provided tear volume less effective. This triggers a vicious cycle in which greater inflammation can subsequently lead to greater damage to surface cells, etc. In addition, because sensory neurons on the ocular surface are damaged, the neural control loop that controls the activation of reflexive tears is disrupted. Therefore, less tears are secreted, and a second vicious cycle occurs that leads to further progression of the disease (less tears lead to nerve cell loss, which in turn leads to less tears, etc.).

Various treatments exist for DED; however, none offer substantial efficacy in treating the aforementioned symptoms. Treatment options include artificial tear substitutes, ointments, gels, warm compresses, environmental modifications, topical cyclosporine, omega-3 fatty acid supplements, lacrimal duct plugs, and moisture chamber lenses. Patients with severe disease may require further treatment with lacrimal duct cauterization, systemic cholinergic agonists, systemic anti-inflammatory agents, mucolytics, autologous serum tears, PROSE scleral contact lenses, and eyelid margin sutures. Despite these treatment options, DED remains one of the worst-treated ophthalmic diseases. Therefore, a more effective dry eye treatment will be needed.

Nicotinic acetylcholine receptors are cholinergic receptors found in the central nervous system (CNS), peripheral nervous system (PNS), and skeletal muscle. These receptors are ligand-gated ion channels with binding sites for acetylcholine and other molecules. When a nicotinic acetylcholine receptor agonist binds to the receptor, it stabilizes the ion channel's open state, allowing the influx of cations such as potassium, calcium, and sodium ions.

Systemic nicotinic acetylcholine receptor agonists, acting on the central nervous system, have attracted attention as drug candidates for a variety of conditions, such as Alzheimer's disease, Parkinson's disease, schizophrenia, attention deficit hyperactivity disorder (ADHD), and nicotine addiction. However, systemic exposure to these central nervous system agents is associated with a number of unwanted psychological side effects, including anxiety, depression, and irritability.

This document describes methods for treating ocular conditions and/or improving ocular surface health, comprising the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors. In some embodiments, the nicotinic acetylcholine receptor agonist binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, the nicotinic acetylcholine receptor agonist binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations and is administered at an amount that is not systemically bioavailable. In some embodiments, the nicotinic acetylcholine receptor agonist binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations and is administered at an amount that does not cause unwanted psychiatric side effects. In some embodiments, the nicotinic acetylcholine receptor agonist binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations and is administered at an amount that does not cause unwanted systemic side effects.

Prolonged or repeated exposure to stimuli often leads to a decrease in the responsiveness of the receptors to those stimuli, a phenomenon known as desensitization. It has been reported that prolonged exposure of nicotinic acetylcholine receptors to agonists can cause agonist-induced conformational changes in the receptors, resulting in receptor desensitization.

This document describes methods for treating ocular conditions and/or improving ocular surface health, comprising topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors, and further comprising topically administering one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, the one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state are selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase A (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors.

This article also describes pharmaceutical formulations for topical application to an individual's nasal cavity, comprising a nicotinic acetylcholine receptor agonist formulated to prevent desensitization. This article also describes pharmaceutical formulations for topical application to an individual's nasal cavity, further comprising one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. This article also describes pharmaceutical formulations for topical application to an individual's nasal cavity, further comprising one or more substances that prevent or reduce the entry of nicotinic acetylcholine receptors into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. This article also describes pharmaceutical formulations for topical application to an individual's nasal cavity, further comprising one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, wherein said one or more substances are selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. This article also describes pharmaceutical formulations for topical application to an individual's nasal cavity, which further comprise one or more substances that prevent or reduce nicotinic acetylcholine receptors from entering a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, wherein said one or more substances are selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors.

Increase tear production

In some embodiments, this document provides a method for increasing tear production in a subject. One embodiment of the method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of the method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. Yet another embodiment of the method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing tear production includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for increasing tear production further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for increasing tear production further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state.

In some embodiments, a method for increasing tear production further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing tear production further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing tear production further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for increasing tear production further includes the topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for increasing tear production further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for increasing tear production further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for increasing tear production further includes the topical application of cyclosporine. In some embodiments, a method for increasing tear production further includes the topical application of pimecrolimus. In some embodiments, a method for increasing tear production further includes the topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above-described embodiments for increasing tear production, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 500 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 750 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, between 5 micrograms and 100 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 50 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 and 50 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 50 and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 and 750 micrograms. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 and 750 micrograms. In yet another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 and 600 micrograms.

In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a wash. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a bottle nebulizer. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nasal cannula. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above-described embodiments for increasing tear production, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid sprayer.

In another embodiment of any of the above embodiments for increasing tear production, the trigeminal nerve is activated. In another embodiment for increasing tear production, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments for increasing tear production, the nasolacrimal reflex is activated.

Treatment of dry eye

In some embodiments, this document provides a method for treating dry eye in a subject. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for treating dry eye includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for treating dry eye further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, a method for treating dry eye further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, a method for treating dry eye further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for treating dry eye further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for treating dry eye further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for treating dry eye further includes the topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for treating dry eye further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for treating dry eye further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for treating dry eye further includes the topical application of cyclosporine. In some embodiments, a method for treating dry eye further includes the topical application of pimecrolimus. In some embodiments, a method for treating dry eye further includes the topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above-described embodiments for treating dry eye, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 500 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 750 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, between 5 micrograms and 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 5 and 50 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 10 and 50 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 25 and 1000 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 50 and 1000 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 100 and 1000 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered in doses between 100 and 750 micrograms into the nasal cavity. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 micrograms and 750 micrograms. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 micrograms and 600 micrograms.

In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an applicator. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above-described embodiments for treating dry eye, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid jet injector.

In another embodiment of any of the above-described embodiments for treating dry eye, the trigeminal nerve is activated. In another embodiment of treating dry eye, the anterior ethmoidal nerve is activated. In another embodiment of any of the above-described embodiments for treating dry eye, the nasolacrimal reflex is activated.

Improve eye discomfort

In some embodiments, this document provides a method for improving ocular discomfort in a subject. One embodiment of a method for improving ocular discomfort includes topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of a method for improving ocular discomfort includes topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. Yet another embodiment of a method for improving ocular discomfort includes topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, methods for improving ocular discomfort include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, methods for improving ocular discomfort include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, methods for improving ocular discomfort include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving eye discomfort includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for improving eye discomfort further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving eye discomfort further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving eye discomfort further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving eye discomfort further includes the topical application of one or more substances that prevent or reduce the entry of nicotinic acetylcholine receptors into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving eye discomfort further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for improving eye discomfort further includes the topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for improving eye discomfort further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for improving eye discomfort further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for improving eye discomfort further includes the topical application of cyclosporine. In some embodiments, a method for improving eye discomfort further includes the topical application of pimecrolimus. In some embodiments, a method for improving eye discomfort further includes the topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with dry eye disease. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with symptoms of dry eye disease. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with symptoms of dry eye disease; wherein the symptoms are selected from itching, dryness, photophobia, blurred vision, pain, stickiness, burning, stinging, and foreign body sensation.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with blepharitis. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with meibomian gland dysfunction. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with allergic conjunctivitis. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with ocular surface poisoning and irritation. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with tear drainage problems. In another embodiment of any of the above-described embodiments for improving eye discomfort, the eye discomfort is associated with eyelid conditions.

In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 500 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 750 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, between 5 micrograms and 100 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 50 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 100 and 750 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 and 750 micrograms. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 and 600 micrograms.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a bottle nebulizer. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a swab. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above-described embodiments for improving eye discomfort, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

In another embodiment of any of the above embodiments for improving eye discomfort, the trigeminal nerve is activated. In another embodiment for improving eye discomfort, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments for improving eye discomfort, the nasolacrimal reflex is activated.

Improve ocular surface health

In some embodiments, this document provides a method for improving ocular surface health in a subject. One embodiment of a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. A third embodiment of a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, methods for improving ocular surface health include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, methods for improving ocular surface health include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, methods for improving ocular surface health include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving ocular surface health includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for improving ocular surface health further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving ocular surface health further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving ocular surface health further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving ocular surface health further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving ocular surface health further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for improving ocular surface health further includes the topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for improving ocular surface health further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for improving ocular surface health further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for improving ocular surface health further includes the topical application of cyclosporine. In some embodiments, a method for improving ocular surface health further includes the topical application of pimecrolimus. In some embodiments, a method for improving ocular surface health further includes the topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 500 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 750 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, between 5 micrograms and 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 5 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 10 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 25 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 50 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 100 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 100 and 750 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 and 750 micrograms. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 and 600 micrograms.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid injector. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a bottle nebulizer. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a swab. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

In another embodiment of any of the above-described embodiments for improving ocular surface health, the trigeminal nerve is activated. In another embodiment of improving ocular surface health, the anterior ethmoidal nerve is activated. In another embodiment of any of the above-described embodiments for improving ocular surface health, the nasolacrimal reflex is activated.

Protect the ocular surface during challenging environmental conditions.

In some embodiments, this document provides a method for protecting the ocular surface of a subject during challenging environmental conditions. One embodiment of this method includes the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of this method includes the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. Finally, another embodiment of this method includes the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, methods for protecting the ocular surface during challenging environmental conditions include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, methods for protecting the ocular surface during challenging environmental conditions include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychiatric side effects. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of a cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of cyclosporine. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of pimecrolimus. In some embodiments, a method for protecting the ocular surface during challenging environmental conditions further includes the topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is scutellarin. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 250 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 500 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 750 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist are administered into the nasal cavity. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 micrograms and 1000 micrograms. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 micrograms and 50 micrograms. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 micrograms and 50 micrograms. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 micrograms and 1000 micrograms. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 50 μg and 1000 μg. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 100 μg and 1000 μg. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 100 μg and 750 μg. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 μg and 750 μg. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered intranasally in amounts between 150 μg and 600 μg.

In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid injector. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder sprayer. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nasal applicator. In another embodiment of any of the above-described embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the trigeminal nerve is activated. In another embodiment of protecting the ocular surface during challenging environmental conditions, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments for protecting the ocular surface during challenging environmental conditions, the nasolacrimal reflex is activated.

Increase the amount of mucin on the surface of the eye

In some embodiments, this document provides a method for increasing the amount of mucin on the ocular surface of a subject. One embodiment of this method involves topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of this method involves topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. A third embodiment of this method involves topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a method for increasing mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a method for increasing mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, a method for increasing mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for increasing the mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing the mucin content on the ocular surface includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for increasing the mucin content on the ocular surface further includes topically administering one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, a method for increasing the mucin content on the ocular surface further includes topically administering one or more substances that prevent or reduce the entry of nicotinic acetylcholine receptors into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of a cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of a calcineurin inhibitor. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of cyclosporine. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of pimecrolimus. In some embodiments, a method for increasing the mucin content on the ocular surface further includes the topical application of tacrolimus.

In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 500 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 750 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, between 5 micrograms and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 100 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 50 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 and 50 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 50 and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 micrograms and 1000 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 micrograms and 750 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 micrograms and 750 micrograms. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 micrograms and 600 micrograms.

In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist has been administered for at least thirty days.

In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid injector. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In another embodiment of any of the above-described embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder sprayer. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nasal applicator. In another embodiment of any of the above embodiments for increasing mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the trigeminal nerve is activated. In another embodiment of increasing the mucin content on the ocular surface, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments for increasing the mucin content on the ocular surface, the nasolacrimal reflex is activated.

Increase the amount or concentration of one or more tear proteins.

In some embodiments, this document provides a method for increasing the amount or concentration of one or more tear proteins in a subject. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins, wherein the tear protein is epithelial growth factor, lactoferrin, lacrimal protein, prolactin, adrenocorticotropic hormone, leucine enkephalin, ALS2CL, ARHGEF19, KIAA1109, PLXNA1, POLG, WIPI1, ZMIZ2, or other proteins of the tear proteome. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is epithelial growth factor. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is lactoferrin. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is lacrimal protein. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is prolactin. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is adrenocorticotropic hormone (ACTH). In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is leucine enkephalin. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is ALS2CL. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is ARHGEF19. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is KIAA1109. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is PLXNA1. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is POLG. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is WIPI1. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, wherein at least one tear protein is ZMIZ2. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, the method further comprising the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state. In some embodiments, a method is used to increase the amount or concentration of one or more tear proteins, the method further comprising the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins is provided, the method further comprising the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptors from entering a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins is provided, further comprising the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins is provided, further comprising the topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins is provided, further comprising the topical application of calcineurin inhibitors. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins is provided, further comprising the topical application of calcineurin inhibitors, said calcineurin inhibitors being selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins further includes topical application of cyclosporine. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins further includes topical application of pimecrolimus. In some embodiments, a method for increasing the amount or concentration of one or more tear proteins further includes topical application of tacrolimus.

In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is terbinafine. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 500 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 750 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 micrograms and 1000 micrograms. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 micrograms and 50 micrograms. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 micrograms and 50 micrograms. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 micrograms and 1000 micrograms. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 50 μg and 1000 μg. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 μg and 1000 μg. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 μg and 750 μg. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 μg and 750 μg. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 μg and 600 μg.

In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above embodiments of increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist has been administered for at least twenty-one days. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist has been administered for at least thirty days.

In another embodiment of any of the above embodiments that increase the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In another embodiment of any of the above-described embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In another embodiment of any of the above-described embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nasal applicator. In another embodiment of any of the above embodiments for increasing the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above embodiments that increase the amount or concentration of one or more tear proteins, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

In another embodiment of any of the above embodiments that increase the amount or concentration of one or more tear proteins, the trigeminal nerve is activated. In another embodiment of any of the above embodiments that increase the amount or concentration of one or more tear proteins, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments that increase the amount or concentration of one or more tear proteins, the nasolacrimal reflex is activated.

Improve tear clearance

In some embodiments, this document provides a method for improving tear clearance in a subject. One embodiment of a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and does not cross the blood-brain barrier at pharmacologically relevant concentrations. Another embodiment of a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. Yet another embodiment of a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, methods for improving tear clearance include topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, methods for improving tear clearance include topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist does not cross the blood-brain barrier at pharmacologically relevant concentrations and selectively binds to peripheral nicotinic acetylcholine receptor subtype α7. In some embodiments, methods for improving tear clearance include topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and is administered in an amount that is not systemically bioavailable. In some embodiments, a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted psychological side effects. In some embodiments, a method for improving tear clearance includes topically administering a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors and the amount does not cause unwanted systemic side effects. In some embodiments, a method for improving tear clearance further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving tear clearance further includes topically administering one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote nicotinic acetylcholine receptor recovery from a desensitized state. In some embodiments, a method for improving tear clearance further includes the topical application of one or more substances that prevent or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving tear clearance further includes the topical application of one or more substances that prevent or reduce nicotinic acetylcholine receptor entry into a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state, said substances being selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a method for improving tear clearance further includes the topical application of protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a method for improving tear clearance further includes topical application of cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA. In some embodiments, a method for improving tear clearance further includes topical application of a calcineurin inhibitor. In some embodiments, a method for improving tear clearance further includes topical application of a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a method for improving tear clearance further includes topical application of cyclosporine. In some embodiments, a method for improving tear clearance further includes topical application of pimecrolimus. In some embodiments, a method for improving tear clearance further includes topical application of tacrolimus.

In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, cytisine, varencrine, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is nicotine. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is cytisine. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is varencrine. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is tebuconazole. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is DBO-83. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is CC4. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is ABT-418. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is ABT-366833. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is ABT-202. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is ABT-894. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is SIB-1663. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is GTS-21. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is PHA-543613. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is PNU-282987. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is LY-2087101. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is A85380. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In another embodiment of any of the above embodiments for improving tear clearance, at least 1 microgram of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 10 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 25 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 50 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 250 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 500 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 750 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, at least 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above embodiments for improving tear clearance, between 5 micrograms and 1000 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 100 micrograms. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 5 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 10 and 50 micrograms. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 25 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 50 and 1000 micrograms. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 μg and 1000 μg. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 100 μg and 750 μg. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 μg and 750 μg. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity in amounts between 150 μg and 600 μg.

In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered once daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered at least once daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered twice daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered at least twice daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered three times daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered at least three times daily. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for one day. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least two days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least three days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least four days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least five days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least seven days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least ten days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least fourteen days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least twenty-one days. In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered for at least thirty days.

In another embodiment of any of the above embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into alternating nostrils.

In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a suspension. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an aerosol. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a gel. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a wash. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder spray device. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an applicator stick. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In another embodiment of any of the above-described embodiments for improving tear clearance, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid jet applicator.

In another embodiment of any of the above embodiments for improving tear clearance, the trigeminal nerve is activated. In another embodiment for improving tear clearance, the anterior ethmoidal nerve is activated. In another embodiment of any of the above embodiments for improving tear clearance, the nasolacrimal reflex is activated.

certain terms

Unless otherwise stated, the following terms as used in this application (including the specification and claims) have the definitions given below. It must be noted that, unless the context clearly indicates otherwise, the singular forms “a/an” and “the” as used in this specification and appended claims include a plural of indicators. In this application, unless otherwise stated, the use of “or” or “and” means “and/or”. Furthermore, the use of the term “comprising” and other forms is not restrictive. Some headings used herein are for organizational purposes only and should not be considered as limiting the subject matter described.

As used herein, the terms “co-administration” and the like are intended to cover the administration of a selected therapeutic agent to a single patient and are intended to include treatment regimens in which the agent is administered via the same or different routes of administration or at the same or different times.

As used herein, the term "effective amount" or "therapeutic effective amount" refers to an amount of a drug or compound administered that is sufficient to alleviate, to a certain extent, one or more symptoms of a disease or condition being treated. The result may be a reduction and/or relief of disease signs, symptoms, or precipitating factors, or any other desired change in a biological system. For example, an "effective amount" for therapeutic use is the amount of a pharmaceutical preparation containing a nicotinic acetylcholine receptor agonist as disclosed herein required to provide a clinically significant reduction in disease symptoms. In any individual case, the appropriate "effective" amount may be determined using techniques such as dose-scaling studies.

The terms “individual,” “subject,” and “patient” encompass both mammals and non-mammals. Examples of mammals include, but are not limited to, any member of the mammal class: humans; non-human primates such as chimpanzees and other apes and monkeys; livestock such as cattle, horses, sheep, goats, and pigs; domestic animals such as rabbits, dogs, and cats; and laboratory animals, including rodents such as rats, mice, and guinea pigs. In one embodiment, the mammal is a human.

A “tissue” comprises two or more types of cells. These two or more types of cells may have similar functions and/or functions. The tissue may be connective tissue, epithelial tissue, muscle tissue, or nerve tissue. Alternatively, the tissue may be bone, tendon (both referred to as musculoskeletal grafts), cornea, skin, heart valves, or veins.

An "organ" comprises two or more tissues. These two or more tissues may perform a specific function or a set of specific functions. In some cases, the organ is the lung, mouth, nose, parathyroid gland, pineal gland, pituitary gland, carotid body, salivary gland, skin, gallbladder, pancreas, small intestine, stomach, spleen, spinal cord, thymus, thyroid gland, trachea, uterus, or appendix. Alternatively, the organ is the adrenal gland, appendix, brain, bladder, kidney, intestine, large intestine, small intestine, liver, heart, or muscle.

The term "nicotinic acetylcholine receptor agonist" encompasses both full and partial agonists of the nicotinic acetylcholine receptor.

As used herein, the term "treatment" includes reducing, alleviating, or improving at least one symptom of a disease or condition; preventing other symptoms; preventing the development of the condition; inhibiting the disease or condition (e.g., halting its development); reducing the disease or condition; resolving the disease or condition; reducing symptoms caused by the disease or condition; or stopping the symptoms of the disease or condition. In one embodiment, treatment is preventive treatment. In another embodiment, treatment refers to therapeutic treatment.

As used in this article, “will not cross the blood-brain barrier at pharmacologically relevant concentrations” means that the amount of nicotinic acetylcholine receptor agonists disclosed herein is insufficient to cross the blood-brain barrier to produce a pharmacological response.

As used in this article, the term "unintended psychological side effects" refers to unintended effects on the brain, including but not limited to anxiety, depression, hallucinations, euphoria, addiction, sleep disorders/disorders, insomnia, unusual dreams, and nightmares.

As used herein, the term "unintended systemic side effects" refers to unintended effects in the body, including but not limited to abdominal pain, vomiting, nausea, constipation, diarrhea, flatulence, indigestion, and dry mouth.

As used herein, the term "nicotinic acetylcholine receptor agonist formulated to prevent desensitization" refers to a formulation that does not induce tolerance, dependence, withdrawal, or desensitization to the effects of nicotinic acetylcholine receptor agonists.

As used herein, the term "environmentally challenging conditions" refers to external conditions, including both natural and anthropogenic conditions. Naturally occurring environmentally challenging conditions include, but are not limited to, exposure to smog, wind, and dry climates. Anthropogenic environmentally challenging conditions include, but are not limited to, exposure to pollution from automobiles, factories, and aircraft, as well as homes/offices with low humidity, high airflow, or poor air quality. In some implementations, "environmentally challenging conditions" refers to controlled challenging environments commonly used in dry eye clinical trials.

The term "eye discomfort" includes, but is not limited to, symptoms of dry eye, such as itching, dryness, photophobia, blurred vision, pain, stickiness, burning, stinging, and a foreign body sensation. In some implementations, eye discomfort is associated with blepharitis, meibomian gland dysfunction, allergic conjunctivitis, ocular surface poisoning and irritation, tear drainage problems, or eyelid conditions.

As used in this article, the term "soft drug" refers to an active pharmaceutical ingredient that is rapidly metabolized into an inactive form immediately after achieving its therapeutic effect.

Nicotinic acetylcholine receptor agonists

The methods described herein involve the local administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is a full agonist. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is a partial agonist. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, scutellarin, varenicline, tebuconazole, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is nicotine. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is cytisine. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is hyoscyamine. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is varencrine. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is tebuconazole. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is DBO-83. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is CC4. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is ABT-418. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is ABT-366833. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is ABT-202. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is ABT-894. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is SIB-1663. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is GTS-21. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is PHA-543613. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is PNU-282987. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is LY-2087101. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is A85380. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is 5-I-A85380. In some embodiments of the method described herein, the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO2010/028011 or WO 2010/028033.

In some embodiments of the method described herein, the nicotinic acetylcholine receptor agonist is a soft drug.

Some embodiments of the method described herein are nicotinic acetylcholine receptor agonists having the following structure:

Or its pharmaceutically acceptable salt.

Intranasal administration route

The methods described herein include the topical application of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need. In some embodiments, the methods described herein include the topical application of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the nicotinic acetylcholine receptor agonist is applied into the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied into the nasal cavity in the form of a liquid. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied into the nasal cavity in the form of a suspension. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied into the nasal cavity in the form of an aerosol. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied into the nasal cavity in the form of a gel. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of an ointment. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a dry powder. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a cream. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a paste. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a lotion. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a balm.

In some embodiments, the methods described herein include the topical administration of a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, or liquid jet injector. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a dropper. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a nebulizer pump. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via an inhaler. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a powder sprayer. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a vaporizer. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a patch. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a swab. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a pipette. In some embodiments of the methods described herein, the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a liquid injector.

Drug formulation, administration method and treatment regimen

This document also provides pharmaceutical formulations of nicotinic acetylcholine receptor agonists for topical application to an individual's nasal cavity. In some embodiments, a pharmaceutical formulation of a nicotinic acetylcholine receptor agonist for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, further comprising one or more substances selected from protein kinase C (PKC) or factors upregulating or upregulating PKC, cAMP-dependent protein kinase (PKA) or factors upregulating or upregulating PKA, and calcineurin inhibitors. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, further comprising protein kinase C (PKC) or factors upregulating or upregulating PKC. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a calcineurin inhibitor. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is cyclosporine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is pimecrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is tacrolimus.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, scutellarin, varenclin, tebuconazole, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is nicotine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is cytisine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is terbinafine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is varencrine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is tebuclam. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is DBO-83. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is CC4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is ABT-418. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is ABT-366833. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is ABT-202. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is ABT-894. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is SIB-1663. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is GTS-21. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is PHA-543613. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is PNU-282987. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is LY-2087101. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is A85380. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO2010/028033.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist selectively binds to peripheral nicotinic acetylcholine receptor subtype α7.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist is a soft drug.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that is not systemically bioavailable, wherein the nicotinic acetylcholine receptor agonist has a structure selected from:

Or its pharmaceutically acceptable salt.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity is also described herein, comprising a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, further comprising one or more substances selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, further comprising protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a calcineurin inhibitor. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is cyclosporine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is pimecrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is tacrolimus.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects. The nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, hyoscyamine, varenicline, tebuconazole, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects. The nicotinic acetylcholine receptor agonist is nicotine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychoactive side effects, wherein the nicotinic acetylcholine receptor agonist is cytisine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychoactive side effects, wherein the nicotinic acetylcholine receptor agonist is valencrine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychoactive side effects, wherein the nicotinic acetylcholine receptor agonist is tebuconazole. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is DBO-83. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is CC4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-418. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-366833. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-202. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-894. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is SIB-1663. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is GTS-21. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is PHA-543613. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is PNU-282987. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is LY-2087101. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is A85380. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist is a soft drug.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist has a structure selected from:

Or its pharmaceutically acceptable salt.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to at least one peripheral nicotinic acetylcholine receptor subtype selected from α3β4, α4β2, and α7. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted psychological side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted psychogenic side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to peripheral nicotinic acetylcholine receptor subtype α7.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity is also described herein, comprising a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, further comprising one or more substances selected from protein kinase C (PKC) or factors that upregulate or upregulate PKC, cAMP-dependent protein kinase (PKA) or factors that upregulate or upregulate PKA, and calcineurin inhibitors. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, further comprising protein kinase C (PKC) or factors that upregulate or upregulate PKC. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a calcineurin inhibitor. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is cyclosporine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is pimecrolimus. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, and further comprises a calcineurin inhibitor, wherein the calcineurin inhibitor is tacrolimus.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects. The nicotinic acetylcholine receptor agonist is selected from nicotine, cytisine, scutellarin, varenclin, tebuconazole, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects. The nicotinic acetylcholine receptor agonist is nicotine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is cytisine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is terbinafine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is valencrine. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is tebuconazole. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is DBO-83. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is CC4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-418. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-366833. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-202. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is ABT-894. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is SIB-1663. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is GTS-21. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is PHA-543613. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is PNU-282987. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is LY-2087101. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is A85380. In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is 5-I-A85380.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is a compound selected from those disclosed in WO 2008/057938, WO 2009/111550, WO 2010/028011 or WO 2010/028033.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist is a soft drug.

In some embodiments, a pharmaceutical preparation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist has a structure selected from:

Or its pharmaceutically acceptable salt.

In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to at least one of peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2, and α7. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α3β4. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in a dose that does not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to the peripheral nicotinic acetylcholine receptor subtype α4β2. In some embodiments, a pharmaceutical formulation for topical application to an individual's nasal cavity comprises a nicotinic acetylcholine receptor agonist formulated to prevent desensitization and in doses that do not cause unwanted systemic side effects, wherein the nicotinic acetylcholine receptor agonist selectively binds to peripheral nicotinic acetylcholine receptor subtype α7.

In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 0.1 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 0.2 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 0.5 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 1 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 2 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 3 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 4 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 5 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 6 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 7 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 8 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 9 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 10 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 12 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 15 mg/mL of the nicotinic acetylcholine receptor agonist. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises about 20 mg/mL of the nicotinic acetylcholine receptor agonist.

In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 1 microgram of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 5 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 10 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 25 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 50 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 100 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 250 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 500 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 750 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises at least 1000 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises between 1 microgram and 1000 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises between 5 micrograms and 1000 micrograms of the nicotinic acetylcholine receptor agonist per dose. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 5 micrograms and 50 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 10 micrograms and 50 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 25 micrograms and 1000 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 50 micrograms and 1000 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 100 micrograms and 1000 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises a nicotinic acetylcholine receptor agonist at a dose between 100 micrograms and 750 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises the nicotinic acetylcholine receptor agonist at a dose between 150 micrograms and 750 micrograms. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation comprises the nicotinic acetylcholine receptor agonist at a dose between 150 micrograms and 600 micrograms.

In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered once daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered at least once daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered twice daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered at least twice daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered three times daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered at least three times daily. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for one day. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for at least two days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for at least three days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for at least four days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for at least five days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered for at least seven days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation has been administered for at least ten days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation has been administered for at least fourteen days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation has been administered for at least twenty-one days. In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation has been administered for at least thirty days.

In another embodiment of any of the above-described pharmaceutical formulation embodiments, the pharmaceutical formulation is administered into alternating nostrils.

In some embodiments, the pharmaceutical preparations described herein are administered for preventative and/or therapeutic treatment. In some therapeutic applications, the pharmaceutical preparation is administered to a patient already suffering from the disease or symptom in an amount sufficient to cure or at least partially block at least one symptom of the disease or symptom. The effective amount for this purpose depends on the severity and course of the disease or symptom, prior therapy, the patient's health status, weight, and response to the drug, as well as the judgment of the treating physician. The therapeutically effective amount may optionally be determined by a variety of methods, including but not limited to dose-escalation clinical trials.

In prophylactic use, the pharmaceutical preparations described herein are administered to patients who are susceptible to or at risk of a particular disease, condition, or symptom. Such a quantity is defined as the “preventative effective amount or dose.” In this application, the exact amount also depends on the patient’s health status, weight, etc. When used on a patient, the effective amount for this purpose will depend on the severity and course of the disease, condition, or symptom, prior therapy, the patient’s health status and response to the drug, and the judgment of the treating physician.

In some implementations, where the patient’s condition does not improve, the physician administers the drug preparation for an extended period of time, including throughout the patient’s life, in order to improve or otherwise control or limit the symptoms of the patient’s disease or condition.

In some implementations, where the patient's condition does not improve, the dosage of the administered drug preparation may be temporarily reduced or temporarily interrupted for a period of time (i.e., a "drug holiday"). In specific implementations, the length of a drug holiday ranges from 2 days to 1 year, including, for example, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 12 days, 15 days, 20 days, 28 days, or more than 28 days. For example, during a drug holiday, the dosage is reduced by 10% to 100%, including, for example, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, and 100%.

In some embodiments, the dosage of the administered pharmaceutical preparation may be temporarily reduced or temporarily interrupted for a period of time (i.e., a "drug change"). In specific embodiments, the length of the drug change is between 2 days and 1 year, including, for example only, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 10 days, 12 days, 15 days, 20 days, 28 days, or more than 28 days. For example only, the dosage is reduced by 10% to 100% during the drug change, including, for example, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, and 100%. After the appropriate length of time, the normal dosing schedule may optionally be resumed.

In some implementations, a maintenance dose is administered as needed once the patient's symptoms have improved. Subsequently, in specific implementations, the dose or frequency, or both, are reduced as symptoms change until the improved disease, condition, or symptom is maintained at a level. However, in some implementations, the patient requires long-term intermittent treatment after any recurrence of symptoms.

The amount of a specified drug corresponding to such a quantity varies depending on many factors, such as the specific drug formulation, the condition and its severity, the characteristics of the subject or host requiring treatment (e.g., weight, sex), but can still be determined based on the specific circumstances of the individual case, including, for example, the specific nicotinic acetylcholine receptor agonist being administered, the condition being treated, and the subject being treated.

As used herein, a pharmaceutical formulation refers to a mixture of a nicotinic acetylcholine receptor agonist as described herein with other chemical components (i.e., pharmaceutically acceptable inactive ingredients), such as carriers, excipients, binders, fillers, suspending agents, disintegrants, dispersants, surfactants, lubricants, colorants, diluents, solubilizers, humectants, plasticizers, stabilizers, penetration enhancers, wetting agents, antifoaming agents, antioxidants, preservatives, or one or more combinations thereof. In some embodiments, the pharmaceutical formulation described herein is mixed with other active ingredients, as in combination therapies. In some embodiments, the pharmaceutical formulation includes other substances of therapeutic value. In other embodiments, the pharmaceutical formulation includes other medical or pharmaceutical reagents, carriers, adjuvants, preservatives, stabilizers, wetting or emulsifying agents, solution promoters, salts and/or buffers for adjusting osmotic pressure.

In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a buffer solution. In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-buffered saline (PBFS). In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-buffered saline (PBFS), wherein the pH of the PBFS is about 7.0. In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-citrate buffer solution. In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-citrate buffer solution, wherein the pH of the phosphate-citrate buffer solution is about 6.0. In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-citrate buffer solution. In some embodiments, the pharmaceutical formulation described herein refers to a mixture of a nicotinic acetylcholine receptor agonist and a phosphate-citrate buffer solution, wherein the pH of the phosphate-citrate buffer solution is about 5.0.

The pharmaceutical formulation facilitates the administration of the compound to a living organism. In practicing the methods described herein, a therapeutically effective amount of the nicotinic acetylcholine receptor agonist described herein is administered in the pharmaceutical formulation to a mammal suffering from the disease, condition, or symptom to be treated. In some embodiments, the mammal is a human. The therapeutically effective amount can vary widely depending on the severity of the disease, the age and relative health of the subject, the potency of the compound used, and other factors. The nicotinic acetylcholine receptor agonist can be used alone or in combination with one or more therapeutic agents as components of a mixture.

The pharmaceutical preparations described herein are administered into the nasal cavity of the subjects. The pharmaceutical preparations described herein include, but are not limited to, liquids, suspensions, aerosols, gels, ointments, dry powders, creams, pastes, lotions, or balms.

Pharmaceutical formulations comprising nicotinic acetylcholine receptor agonists as described herein are manufactured using conventional methods.

The pharmaceutical composition will include, as an active ingredient, a nicotinic acetylcholine receptor agonist as described herein, in the form of a free acid or free base, or in the form of a pharmaceutically acceptable salt. Additionally, the methods and pharmaceutical formulations described herein include N-oxides (where appropriate), crystalline forms, amorphous phases, and active metabolites of the same type of activity using these nicotinic acetylcholine receptor agonists. In some embodiments, the nicotinic acetylcholine receptor agonists described herein may be in a nonsolvent form or in a solvate form with a pharmaceutically acceptable solvent such as water, ethanol, etc. The solvate forms of the nicotinic acetylcholine receptor agonists provided herein are also considered to be disclosed herein. In some embodiments, the compound may be present as a tautomer. All tautomers are included within the scope of the nicotinic acetylcholine receptor agonists provided herein.

In some embodiments, the nicotinic acetylcholine receptor agonist is present as an enantiomer, diastereomer, or other stereoisomer. The nicotinic acetylcholine receptor agonists disclosed herein include all enantiomers, diastereomers, and epimers, as well as mixtures thereof.

In some embodiments, the pharmaceutical formulations provided herein include one or more preservatives to inhibit microbial activity. Suitable preservatives include mercury-containing substances, such as phenylmercuric borate and thimerosal; stable chlorine dioxide; and quaternary ammonium compounds, such as benzalkonium chloride, hexadecyltrimethylammonium bromide, and hexadecylpyridine chloride.

In some embodiments, the pharmaceutical formulations described herein benefit from antioxidants, metal chelators, thiol compounds, and other general stabilizers. Examples of such stabilizers include, but are not limited to: (a) about 0.5% to about 2% w/v glycerol; (b) about 0.1% to about 1% w/v methionine; (c) about 0.1% to about 2% w/v monothioglycerol; (d) about 1 mM to about 10 mM EDTA; (e) about 0.01% to about 2% w/v ascorbic acid; (f) 0.003% to about 0.02% w/v polysorbate 80; (g) 0.001% to about 0.05% w/v polysorbate 20; (h) arginine; (i) heparin; (j) dextran sulfate; (k) cyclodextrin; (l) pentosan polysulfate and other heparin-like substances; (m) divalent cations, such as magnesium and zinc; or (n) combinations thereof.

The pharmaceutical formulations comprising nicotinic acetylcholine receptor agonists described herein are formulated in any suitable dosage form, including but not limited to liquids, suspensions, aerosols, gels, ointments, dry powders, creams, pastes, lotions, or balms. The pharmaceutical formulations comprising nicotinic acetylcholine receptor agonists described herein are formulated in any suitable dosage form for administration into the nasal cavity via syringes, droppers, bottle-type nebulizers, nebulizer pumps, inhalers, powder sprayers, vaporizers, patches, applicators, pipettes, or liquid injectors.

Combination therapy

In some cases, it is appropriate to administer a combination of a nicotinic acetylcholine receptor agonist and another therapeutic agent.

In one embodiment, the compositions and methods described herein are also used in combination with other therapeutic agents selected because they are particularly useful for the condition being treated. Generally, the compositions described herein do not need to be administered in the same pharmaceutical formulation or composition with other agents (in embodiments employing combination therapy), and are administered via different routes due to their different physical and chemical characteristics. In one embodiment, an initial administration is performed according to a predetermined regimen, followed by further adjustments to the dosage, administration pattern, and timing based on observed effects.

In various embodiments, nicotinic acetylcholine receptor agonists are administered concurrently (e.g., simultaneously, substantially simultaneously, or within the same treatment regimen) or sequentially with other therapeutic agents selected because they are particularly useful for the condition being treated. In some embodiments, the order of administration and number of repetitions of each therapeutic agent during the treatment regimen are determined based on an assessment of the disease being treated and the patient's condition.

In some embodiments, the nicotinic acetylcholine receptor agonist is administered concurrently (e.g., simultaneously, substantially simultaneously, or within the same treatment regimen) or sequentially with another therapeutic agent used to treat dry eye disease. In some embodiments, the nicotinic acetylcholine receptor agonist is administered concurrently (e.g., simultaneously, substantially simultaneously, or within the same treatment regimen) or sequentially with eye drops. In some embodiments, the nicotinic acetylcholine receptor agonist is administered concurrently (e.g., simultaneously, substantially simultaneously, or within the same treatment regimen) or sequentially with artificial tears. In some embodiments, the nicotinic acetylcholine receptor agonist is administered concurrently (e.g., simultaneously, substantially simultaneously, or within the same treatment regimen) or sequentially with ophthalmic steroids.

For the combination therapies described in this article, the dosage of the co-administered compounds varies depending on the type of shared drug used, the specific drug used, the disease or symptom being treated, etc.

Individual compounds in such combinations are administered sequentially or simultaneously in pharmaceutical formulations, either alone or in combination. In one embodiment, the individual compounds are administered simultaneously in a combined pharmaceutical formulation. Those skilled in the art will understand the appropriate dosage of known therapeutic agents.

The combinations mentioned herein are suitable for use in the form of pharmaceutical compositions with pharmaceutically acceptable diluents or carriers.

As used herein, the combination of administration of agents includes administration of the described agents in a single composition or in combination therapy, wherein one or more agents are administered separately from at least one other agent.

In some embodiments, administration of a nicotinic acetylcholine receptor agonist is combined with the use of a medical device. In some embodiments, administration of a nicotinic acetylcholine receptor agonist is combined with the use of a lacrimal duct plug.

Example

The following specific examples should be considered illustrative only and in no way limit the remainder of the invention.

Example 1a: Clinical trial evaluating the safety and efficacy of nasal administration of the nicotinic acetylcholine receptor agonist varencrine for the treatment of dry eye disease (DED).

Objective: This study evaluated the use of varencrine 0.1% nasal spray (OC-01) in the treatment of moderate to severe dementia (DED) in adult patients. The study investigated the safety and efficacy of using OC-01 to induce aqueous tear production and alleviate DED symptoms.

Patients: A total of 30 participants with moderate to severe dry eye who met the following inclusion and exclusion criteria were enrolled.

Guidelines:

Included:

• Males and females aged 18 and above

• Willing to sign informed consent form and deemed able to comply with the requirements of the research protocol.

• At the first screening, the Hiller tear test (using local anesthesia) of at least one eye should be ≤10mm/5min;

• At the first screening, the Hiller test (using local anesthesia and nasal stimulation with a cotton swab) in at least one eye was at least 7 mm higher than the value in the unstimulated eye;

• A baseline ocular surface disease index score of at least 23, with no more than 3 "not applicable" responses at the first screening.

Normal eyelid/eyelash anatomy, blinking function, and closure.

exclude:

Chronic or recurrent nosebleeds

• Use of tobacco or nicotine products (cigarettes, cigars, e-cigarettes) within the past year

• Coagulation disorders that may increase bleeding, such as hemophilia and thrombocytopenia.

• Formation of a tumor in the lacrimal gland, nose, or sinus, or major trauma; previous surgery or removal of the lacrimal gland, nose, or sinus, resulting in denervation of the gland or nasal passage, as demonstrated by a lack of response to nasal stimulation with a cotton swab.

• Severe nasal airway obstruction (e.g., severe nasal septum deviation or inferior turbinate hypertrophy)

• Underwent eye surgery (such as refractive surgery or cataract surgery) in either eye within 3 months of the first screening;

• Unstable or systemic conditions or diseases deemed incompatible with participation in the study by the investigator (e.g., current systemic infection, uncontrolled autoimmune disease, uncontrolled immunodeficiency, history of myocardial infarction, uncontrolled hypertension, etc.) or incompatible with the frequent evaluations required for the study.

• The history or presence of any ocular condition or symptom in either eye that could potentially interfere with the interpretation of research results or patient safety, such as significant corneal or conjunctival scarring, pterygium, or pinguecula nodosa; current ocular infection or inflammation unrelated to dry eye; clinically significant anterior (epithelial) basement membrane corneal dystrophy or other clinically significant corneal dystrophy or degeneration; clinically significant blepharitis; ocular herpetic infection, etc.

• Known allergy to any procedural reagents or materials in the investigational drug that come into contact with the nasal mucosa.

• Active or uncontrolled severe systemic allergies, chronic seasonal allergies, rhinitis, or sinusitis that require treatment at initial screening (i.e., antihistamines, decongestants, oral or aerosol steroids).

• Currently undergoing any medication therapy known to cause dry eyes (e.g., cyclosporine, antihistamines, tricyclic antidepressants, anxiolytics, antimuscarinic agents, beta-blockers, diuretics, phenothiazines, steroids, etc.), and not using the medication according to a stable dosing regimen for 30 days prior to the first screening.

• Soluble lacrimal duct embolization (participants with silicone embolization or permanent lacrimal duct obstruction are eligible)

• Active contact lenses should not be used unless interrupted for at least 7 days prior to the first screening and during the duration of the study.

• Participated in any clinical trials utilizing new active substances or new devices within the past 3 months.

• Women who are pregnant, planning to become pregnant, or breastfeeding at the start of the study. Urine pregnancy tests will be administered to women of childbearing age.

• Known allergy to varencrine or adverse reactions.

• Any unstable or uncontrolled cardiac, pulmonary, renal, oncological, neurological, metabolic, or other systemic conditions that the researchers believe would warrant urgent medical attention during this study. This includes, but is not limited to, cardiac arrhythmias, hypertension, coagulation disorders, kidney failure, and diabetes.

Including/excluding exceptions:

Researchers have the right to exclude any patient from a study when they believe it is in the best interests of the patient.

Minor exceptions to the inclusion/exclusion criteria should be submitted to the sponsor and are expected to be approved for notification to the medical monitor if necessary.

Major exceptions affecting patient safety/rights or data validity will be promptly reported by the investigator to the IRB/EC.

Main results: The design of this study will enable the following measurements regarding OC-01 and tear production:

• Changes in tear production associated with a single dose of OC-01

Secondary results: The design of this study will enable the following measurements regarding OC-01 and tear production:

• Changes in tear production associated with a single dose of the medium

Symptom changes associated with a single dose of OC-01

Duration of symptom relief associated with a single dose of OC-01

• Symptom changes associated with a single dose of the vehicle

Duration of symptom relief associated with a single dose of the drug

In summary, these comparisons will provide valuable information regarding the safety and efficacy of OC-01 in increasing tear production in patients with dry eye disease.

The primary safety endpoint of this study is the correlation between morbidity and adverse events (AEs). Descriptive statistics of adverse events will be provided, along with a description of any serious, unexpected, or drug-related AEs. Nasal passage integrity will be monitored by qualified professionals throughout the study for patient safety.

Study Design: This study is a prospective, single-arm crossover study evaluating the safety and efficacy of OC-01 varencrine 0.1% nasal spray in participants with moderate to severe dry eye. Up to 30 participants will be enrolled and followed for seven days.

At the initial screening, all eligible participants agreed to discontinue their current use of artificial tears or lubricating eye drops for the duration of the study and were provided with a unit dose of preservative-free artificial tears for use when their dry eye symptoms became unbearable. Empty unit dose vials were collected and counted at each study visit. Patients were advised not to use artificial tears within 30 minutes of nasal application or within 2 hours of the study visit.

On Day 0 of the second screening/study, all eligible participants will be tested for their response to two nasal formulations: OC-01 and a mediator control. Tear production in both eyes will be evaluated using the Jones Hillmer test immediately before and after each intranasal dose. Patients will be randomly assigned to receive the OC-01 and mediator formulations in a manner unknown to both patients and examiners. At least 90 minutes after tear production evaluation, changes in symptoms in response to each of the two nasal formulations will be assessed. Symptom assessment will be conducted using a well-established environmental challenge model, namely the ClimaTears goggle system manufactured by Biocentric Developments, LLC.

After testing on day 0, all patients will receive a bottle of OC-01 to take home and self-administer once daily on days 1 and 6. On day 7, patients will return to the outpatient clinic for a further evaluation of their tear production and symptoms with each nasal preparation used.

Tear evaluation

The ocular surface and tear film will be evaluated in the order shown:

Ocular surface staining – corneal staining using fluorescein

The ocular surface staining using fluorescein and lissamine green will be evaluated and recorded on the case report form using the National Eye Society grading system, in schematic diagrams of five corneal areas and six conjunctival areas for each eye. The case report form (CRF) includes both illustrative and descriptive grading scales (grades 0 to 3).

1. A 1.0 mg sodium fluorescein test strip will be used to evaluate corneal staining.

2. After wetting the end of the test piece with a drop of buffered saline, shake the excess saline into the waste bin by rapidly flicking it.

3. Next, pull down the lower eyelid and gently apply the flat tip of the dye to the lower tarsal conjunctiva, intending to instill a very small volume of dye without inducing reflexive tearing.

4. Instruct the patient to blink naturally several times without forcibly closing their eyelids to distribute the fluorescein.

5. After allowing the fluorescein to remain on the eye for at least one minute, five corneal regions will be graded using a yellow (Wratten #12) barrier filter, along with a cobalt (blue) filter, to maximize fluorescence observation. Slightly lift the upper eyelid to allow grading of the entire corneal surface. To enhance contrast, position the yellow barrier filter in the path of the returning light (rather than in the path of the incident light).

Tear film breakup time (TFBUT)

TFBUT will be evaluated using slit-lamp biopsy according to the following steps:

1. Set the slit lamp to approximately 10x magnification.

2. With the fluorescein fully in place (preferably using a DET test strip), the subject will be asked to stare straight ahead without blinking until informed that this is not necessary. The test should be conducted indoors with no direct airflow over the patient's face.

3. A stopwatch will be used to record the time between the last complete blink and the first appearance of growth micelles that indicate tear film rupture.

Note: If the patient blinks too early before the tear film breaks down, the examiner will continue trying to obtain a reading.

4. Once TFBUT is observed, instruct the patient to blink freely. Then repeat the test a second time on the same eye.

5. If the difference between the first and second readings exceeds two seconds, a third measurement should be performed and recorded.

6. The procedure will then be performed in the other eye.

7. It is recommended to perform TFBUT indoors at a temperature of approximately 18°C and a humidity of approximately 50%.

Ocular surface staining – conjunctival staining using erythromycin green

The ocular surface staining evaluation will be completed using lissamine green conjunctival staining.

1. Moisten the Lissamide Green ophthalmic test strip with buffered saline and apply it to the conjunctiva of the lower eyelid. Carefully instill sufficient dye.

2. After allowing erythromycin green to remain on the eyes for one minute, the six nasal and temporal conjunctival areas will be graded.

3. To classify the temporal region, the subject should be instructed to look towards the nose; to classify the nasal region, the subject should be instructed to look towards the temporal region.

4. The procedure will then be completed in the other eye.

Hilmer Test

During the first screening, a basic Jones-Hilmer test will be performed, followed by a Hillmer test using nasal stimulation with a cotton swab. The Jones-Hilmer test, using a local anesthetic, will be used to evaluate tear production, following these steps:

1. Local anesthetic eye drops, such as 0.5% paracaine hydrochloride or equivalent, should be instilled into the patient's eyes.

2. Instruct the patient to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about one minute, gently remove excess moisture from the lower fornix using a cotton swab applicator.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, instruct the patient to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the patient's face.

6. After five minutes, remove the test strips from both eyes and record the amount of wetting. Attach the test strips to the CRF with tape. Note: If the Hillmer score reaches its maximum before the 5-minute end, the test strips can be removed and the time taken to reach that maximum can be recorded. However, the test strips should not be removed from the contralateral eye until it also reaches its maximum score before the 5-minute end.

7. When performing multiple Hiller tests, new anesthetic eye drops should be added as necessary.

The Hiller test using a cotton swab to stimulate the nose.

1. During the first screening, the Hiller test will be performed using a cotton swab nasal stimulation. With a new swab in place, the examiner will simultaneously insert the swab into both nostrils of the participant and gently probe the two middle turbinates for approximately 30 seconds. Afterward, the examiner may simply keep the swab in place, apply slight pressure, and repeat the probe intermittently as needed.

2. Alternatively, participants can be instructed to hold a cotton swab and gently probe both nasal turbinates simultaneously, taking intermittent breaks before probing again. The examiner will provide ongoing guidance on how to properly perform the test.

3. Keep the Hilmer test film in place until five minutes have passed or it has reached its maximum score.

Two Hillmer scores will be recorded and their compliance with inclusion criteria will be verified. New anesthetic eye drops should be administered if necessary during both Hillmer tests.

Hillmer tests were conducted on each of the two nasal spray applications.

Using each of the two nasal spray applications, the Jones-Hilmer test using a local anesthetic will be used to evaluate tear production, following the steps below:

1. For each application, administer local anesthetic eye drops, such as 0.5% paracaine hydrochloride or an equivalent, into the participant's eyes.

2. Participants will be instructed to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about a minute, gently remove excess water from the lower fornix with a small fork.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, participants will be instructed to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the participant's face.

6. After five minutes, the test strip will be removed from both eyes and the amount of wetting will be recorded. The test strip will then be taped to the CRF.

Dry eye irritation and symptom evaluation

The ClimaTears goggle system (Biocentric Developments, LLC) will be used to reduce periocular humidity and induce dry eye symptoms in patients. This system is designed for the purpose of standardizing testing conditions in clinical studies of dry eye patients.

Patients will wear ClimaTears goggles continuously for up to 90 minutes, recording their symptoms every 5 minutes during the test period using a Visual Analogue Scale (VAS). Subjects will be asked to rate their dryness symptoms (both eyes, simultaneously) by placing vertical markers on a horizontal line to indicate the level of discomfort. 0 corresponds to "no dryness," and 5 corresponds to "maximum dryness." The rating line length will be 100 mm (Figure 3).

On Day 0, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45mm or higher. At this point, they will be randomly assigned to receive either a dose of OC-01 nasal spray or a control nasal spray, administered 2.5 minutes after two consecutive 45mm measurements. Symptom monitoring will continue until the patient again reaches a score of 45mm or higher. At this point, the patient will receive a second nasal dose of any test item not received on the first attempt. After the second nasal dose, symptoms will be monitored again until the patient reaches a score of 45mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles. At the end of this period, each patient will be asked to indicate which nasal spray provided the greatest relief for their dry eye symptoms.

On day 7, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45 mm or higher. At this point, they will receive one dose of OC-01 nasal spray. Symptom monitoring will continue until the patient again has two consecutive measurements reaching a score of 45 mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles.

Patients with a baseline symptom score greater than 45 mm upon admission will have a treatment threshold equal to that baseline score and will therefore be treated after having two consecutive symptom measurements greater than or equal to that value.

Before the test begins and immediately after administering any nasal spray, before recording symptom values, read the instructions (in bold above) to the patient.

Results of tear film evaluation and dry eye symptoms: Patients receiving OC-01 showed a statistically significant increase in tear production compared to baseline and placebo (Figure 1). Furthermore, compared to placebo patients, patients receiving OC-01 also reported improved dry eye symptoms (Figure 2).

Example 1b: Clinical trial evaluating the safety and efficacy of cytisine, a nicotinic acetylcholine receptor agonist, for the treatment of dry eye disease (DED).

Objective: This study evaluated the use of 0.1% cytisine nasal spray (OC-02) in the treatment of moderate to severe dementia (DED) in adult patients. The study investigated the safety and efficacy of using OC-02 to induce aqueous tear production and alleviate DED symptoms.

Patients: A total of 30 participants with moderate to severe dry eye who meet the following inclusion and exclusion criteria will be enrolled.

Guidelines:

Included:

• Males and females aged 18 and above

• Willing to sign informed consent form and deemed able to comply with the requirements of the research protocol.

• At the first screening, the Hiller tear test (using local anesthesia) of at least one eye should be ≤10mm/5min;

• At the first screening, the Hiller test (using local anesthesia and nasal stimulation with a cotton swab) in at least one eye was at least 7 mm higher than the value in the unstimulated eye;

• A baseline ocular surface disease index score of at least 23, with no more than 3 "not applicable" responses at the first screening.

Normal eyelid/eyelash anatomy, blinking function, and closure.

exclude:

Chronic or recurrent nosebleeds

• Use of tobacco or nicotine products (cigarettes, cigars, e-cigarettes) within the past year

• Coagulation disorders that may increase bleeding, such as hemophilia and thrombocytopenia.

• Formation of a tumor in the lacrimal gland, nose, or sinus, or major trauma; previous surgery or removal of the lacrimal gland, nose, or sinus, resulting in denervation of the gland or nasal passage, as demonstrated by a lack of response to nasal stimulation with a cotton swab.

• Severe nasal airway obstruction (e.g., severe nasal septum deviation or inferior turbinate hypertrophy)

• Underwent eye surgery (such as refractive surgery or cataract surgery) in either eye within 3 months of the first screening;

• Unstable or systemic conditions or diseases deemed incompatible with participation in the study by the investigator (e.g., current systemic infection, uncontrolled autoimmune disease, uncontrolled immunodeficiency, history of myocardial infarction, uncontrolled hypertension, etc.) or incompatible with the frequent evaluations required for the study.

• The history or presence of any ocular condition or symptom in either eye that could potentially interfere with the interpretation of research results or patient safety, such as significant corneal or conjunctival scarring, pterygium, or pinguecula nodosa; current ocular infection or inflammation unrelated to dry eye; clinically significant anterior (epithelial) basement membrane corneal dystrophy or other clinically significant corneal dystrophy or degeneration; clinically significant blepharitis; ocular herpetic infection, etc.

• Known allergy to any procedural reagents or materials in the investigational drug that come into contact with the nasal mucosa.

• Active or uncontrolled severe systemic allergies, chronic seasonal allergies, rhinitis, or sinusitis that require treatment at initial screening (i.e., antihistamines, decongestants, oral or aerosol steroids).

• Currently undergoing any medication therapy known to cause dry eyes (e.g., cyclosporine, antihistamines, tricyclic antidepressants, anxiolytics, antimuscarinic agents, beta-blockers, diuretics, phenothiazines, steroids, etc.), and not using the medication according to a stable dosing regimen for 30 days prior to the first screening.

• Soluble lacrimal duct embolization (participants with silicone embolization or permanent lacrimal duct obstruction are eligible)

• Active contact lenses should not be used unless interrupted for at least 7 days prior to the first screening and during the duration of the study.

• Participated in any clinical trials utilizing new active substances or new devices within the past 3 months.

• Women who are pregnant, planning to become pregnant, or breastfeeding at the start of the study. Urine pregnancy tests will be administered to women of childbearing age.

• Known allergy to cytisine or adverse reactions.

• Any unstable or uncontrolled cardiac, pulmonary, renal, oncological, neurological, metabolic, or other systemic conditions that the researchers believe would warrant urgent medical attention during this study. This includes, but is not limited to, cardiac arrhythmias, hypertension, coagulation disorders, kidney failure, and diabetes.

Including/excluding exceptions:

Researchers have the right to exclude any patient from a study when they believe it is in the best interests of the patient.

Minor exceptions to the inclusion/exclusion criteria should be submitted to the sponsor and are expected to be approved for notification to the medical monitor if necessary.

Major exceptions affecting patient safety/rights or data validity will be promptly reported by the investigator to the IRB/EC.

Main results: The design of this study will enable the following measurements regarding OC-02 and tear production:

• Changes in tear production associated with a single dose of OC-02

Secondary results: The design of this study will enable the following measurements regarding OC-02 and tear production:

• Changes in tear production associated with a single dose of the medium

Symptom changes associated with a single dose of OC-02

Duration of symptom relief associated with a single dose of OC-02

• Symptom changes associated with a single dose of the vehicle

Duration of symptom relief associated with a single dose of the drug

In summary, these comparisons will provide valuable information regarding the safety and efficacy of OC-02 in increasing tear production in patients with dry eye disease.

The primary safety endpoint of this study is the correlation between morbidity and adverse events (AEs). Descriptive statistics of adverse events will be provided, along with a description of any serious, unexpected, or drug-related AEs. Nasal passage integrity will be monitored by qualified professionals throughout the study for patient safety.

Study Design: This study is a prospective, single-arm crossover study to evaluate the safety and efficacy of OC-02 cytisine 0.1% nasal spray in participants with moderate to severe dry eye. Up to 30 participants will be enrolled and followed for seven days.

At the initial screening, all eligible participants agreed to discontinue their current use of artificial tears or lubricating eye drops for the duration of the study and were provided with a unit dose of preservative-free artificial tears for use when their dry eye symptoms became unbearable. Empty unit dose vials were collected and counted at each study visit. Patients were advised not to use artificial tears within 30 minutes of nasal application or within 2 hours of the study visit.

On Day 0 of the second screening/study, all eligible participants will be tested for their response to two nasal formulations: OC-02 and a mediator control. Tear production in both eyes will be evaluated using the Jones Hillmer test immediately before and after each intranasal dose. Patients will be randomly assigned to receive the OC-02 and mediator formulations in a manner unknown to both patients and examiners. At least 90 minutes after tear production evaluation, changes in symptoms in response to each of the two nasal formulations will be assessed. Symptom assessment will be conducted using a well-established environmental challenge model, namely the ClimaTears goggle system manufactured by Biocentric Developments, LLC.

After testing on day 0, all patients will receive a bottle of OC-02 to take home and self-administer once daily on days 1 and 6. On day 7, patients will return to the outpatient clinic for a further evaluation of their tear production and symptoms with each nasal preparation used.

Tear evaluation

The ocular surface and tear film will be evaluated in the order shown:

Ocular surface staining – corneal staining using fluorescein

The ocular surface staining using fluorescein and lissamine green will be evaluated and recorded on the case report form using the National Eye Society grading system, in schematic diagrams of five corneal areas and six conjunctival areas for each eye. The case report form (CRF) includes both illustrative and descriptive grading scales (grades 0 to 3).

1. A 1.0 mg sodium fluorescein test strip will be used to evaluate corneal staining.

2. After wetting the end of the test piece with a drop of buffered saline, shake the excess saline into the waste bin by rapidly flicking it.

3. Next, pull down the lower eyelid and gently apply the flat tip of the dye to the lower tarsal conjunctiva, intending to instill a very small volume of dye without inducing reflexive tearing.

4. Instruct the patient to blink naturally several times without forcibly closing their eyelids to distribute the fluorescein.

5. After allowing the fluorescein to remain on the eye for at least one minute, five corneal regions will be graded using a yellow (Wratten #12) barrier filter, along with a cobalt (blue) filter, to maximize fluorescence observation. Slightly lift the upper eyelid to allow grading of the entire corneal surface. To enhance contrast, position the yellow barrier filter in the path of the returning light (rather than in the path of the incident light).

Tear film breakup time (TFBUT)

TFBUT will be evaluated using slit-lamp biopsy according to the following steps:

1. Set the slit lamp to approximately 10x magnification.

2. With the fluorescein fully in place (preferably using a DET test strip), the subject will be asked to stare straight ahead without blinking until informed that this is not necessary. The test should be conducted indoors with no direct airflow over the patient's face.

3. A stopwatch will be used to record the time between the last complete blink and the first appearance of growth micelles that indicate tear film rupture.

Note: If the patient blinks too early before the tear film breaks down, the examiner will continue trying to obtain a reading.

4. Once TFBUT is observed, instruct the patient to blink freely. Then repeat the test a second time on the same eye.

5. If the difference between the first and second readings exceeds two seconds, a third measurement should be performed and recorded.

6. The procedure will then be performed in the other eye.

7. It is recommended to perform TFBUT indoors at a temperature of approximately 18°C and a humidity of approximately 50%.

Ocular surface staining – conjunctival staining using erythromycin green

The ocular surface staining evaluation will be completed using lissamine green conjunctival staining.

1. Moisten the Lissamide Green ophthalmic test strip with buffered saline and apply it to the conjunctiva of the lower eyelid. Carefully instill sufficient dye.

2. After allowing erythromycin green to remain on the eyes for one minute, the six nasal and temporal conjunctival areas will be graded.

3. To classify the temporal region, the subject should be instructed to look towards the nose; to classify the nasal region, the subject should be instructed to look towards the temporal region.

4. The procedure will then be completed in the other eye.

Hilmer Test

During the first screening, a basic Jones-Hilmer test will be performed, followed by a Hillmer test using nasal stimulation with a cotton swab. The Jones-Hilmer test, using a local anesthetic, will be used to evaluate tear production, following these steps:

1. Local anesthetic eye drops, such as 0.5% paracaine hydrochloride or equivalent, should be instilled into the patient's eyes.

2. Instruct the patient to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about one minute, gently remove excess moisture from the lower fornix using a cotton swab applicator.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, instruct the patient to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the patient's face.

6. After five minutes, remove the test strips from both eyes and record the amount of wetting. Attach the test strips to the CRF with tape. Note: If the Hillmer score reaches its maximum before the 5-minute end, the test strips can be removed and the time taken to reach that maximum can be recorded. However, the test strips should not be removed from the contralateral eye until it also reaches its maximum score before the 5-minute end.

7. When performing multiple Hiller tests, new anesthetic eye drops should be added as necessary.

The Hiller test using a cotton swab to stimulate the nose.

1. During the first screening, the Hiller test will be performed using a cotton swab nasal stimulation. With a new swab in place, the examiner will simultaneously insert the swab into both nostrils of the participant and gently probe the two middle turbinates for approximately 30 seconds. Afterward, the examiner may simply keep the swab in place, apply slight pressure, and repeat the probe intermittently as needed.

2. Alternatively, participants can be instructed to hold a cotton swab and gently probe both nasal turbinates simultaneously, taking intermittent breaks before probing again. The examiner will provide ongoing guidance on how to properly perform the test.

3. Keep the Hilmer test film in place until five minutes have passed or it has reached its maximum score.

Two Hillmer scores will be recorded and their compliance with inclusion criteria will be verified. New anesthetic eye drops should be administered if necessary during both Hillmer tests.

Hillmer tests were conducted on each of the two nasal spray applications.

Using each of the two nasal spray applications, the Jones-Hilmer test using a local anesthetic will be used to evaluate tear production, following the steps below:

1. For each application, administer local anesthetic eye drops, such as 0.5% paracaine hydrochloride or an equivalent, into the participant's eyes.

2. Participants will be instructed to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about a minute, gently remove excess water from the lower fornix with a small fork.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, participants will be instructed to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the participant's face.

6. After five minutes, the test strip will be removed from both eyes and the amount of wetting will be recorded. The test strip will then be taped to the CRF.

Dry eye irritation and symptom evaluation

The ClimaTears goggle system (Biocentric Developments, LLC) will be used to reduce periocular humidity and induce dry eye symptoms in patients. This system is designed for the purpose of standardizing testing conditions in clinical studies of dry eye patients.

Patients will wear ClimaTears goggles continuously for up to 90 minutes, recording their symptoms every 5 minutes during the test period using a Visual Analogue Scale (VAS). Subjects will be asked to rate their dryness symptoms (both eyes, simultaneously) by placing vertical markers on a horizontal line to indicate the level of discomfort. 0 corresponds to "no dryness," and 5 corresponds to "maximum dryness." The rating line length will be 100 mm (Figure 3).

On Day 0, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45mm or higher. At this point, they will be randomly assigned to receive either a dose of OC-02 nasal spray or a control nasal spray, administered 2.5 minutes after two consecutive 45mm measurements. Symptom monitoring will continue until the patient again reaches a score of 45mm or higher. At this point, the patient will receive a second nasal dose of any test item not received on the first attempt. After the second nasal dose, symptoms will be monitored again until the patient reaches a score of 45mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles. At the end of this period, each patient will be asked to indicate which nasal spray provided the greatest relief for their dry eye symptoms.

On day 7, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45 mm or higher. At this point, they will receive one dose of OC-02 nasal spray. Symptom monitoring will continue until the patient again has two consecutive measurements reaching a score of 45 mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles.

Patients with a baseline symptom score greater than 45 mm upon admission will have a treatment threshold equal to that baseline score and will therefore be treated after having two consecutive symptom measurements greater than or equal to that value.

Before the test begins and immediately after administering any nasal spray, before recording symptom values, read the instructions (in bold above) to the patient.

Example 1c: Clinical trial evaluating the safety and efficacy of nasal administration of the nicotinic acetylcholine receptor agonist dichotyrosine for the treatment of dry eye disease (DED).

Objective: This study evaluated the use of 0.1% nasal spray (OC-03) of arbutin for the treatment of moderate to severe dementia (DED) in adult patients. The study investigated the safety and efficacy of OC-03 in inducing aqueous tear production and alleviating DED symptoms.

Patients: A total of 30 participants with moderate to severe dry eye who meet the following inclusion and exclusion criteria will be enrolled.

Guidelines:

Included:

• Males and females aged 18 and above

• Willing to sign informed consent form and deemed able to comply with the requirements of the research protocol.

• At the first screening, the Hiller tear test (using local anesthesia) of at least one eye should be ≤10mm/5min;

• At the first screening, the Hiller test (using local anesthesia and nasal stimulation with a cotton swab) in at least one eye was at least 7 mm higher than the value in the unstimulated eye;

• A baseline ocular surface disease index score of at least 23, with no more than 3 "not applicable" responses at the first screening.

Normal eyelid/eyelash anatomy, blinking function, and closure.

exclude:

Chronic or recurrent nosebleeds

• Use of tobacco or nicotine products (cigarettes, cigars, e-cigarettes) within the past year

• Coagulation disorders that may increase bleeding, such as hemophilia and thrombocytopenia.

• Formation of a tumor in the lacrimal gland, nose, or sinus, or major trauma; previous surgery or removal of the lacrimal gland, nose, or sinus, resulting in denervation of the gland or nasal passage, as demonstrated by a lack of response to nasal stimulation with a cotton swab.

• Severe nasal airway obstruction (e.g., severe nasal septum deviation or inferior turbinate hypertrophy)

• Underwent eye surgery (such as refractive surgery or cataract surgery) in either eye within 3 months of the first screening;

• Unstable or systemic conditions or diseases deemed incompatible with participation in the study by the investigator (e.g., current systemic infection, uncontrolled autoimmune disease, uncontrolled immunodeficiency, history of myocardial infarction, uncontrolled hypertension, etc.) or incompatible with the frequent evaluations required for the study.

• The history or presence of any ocular condition or symptom in either eye that could potentially interfere with the interpretation of research results or patient safety, such as significant corneal or conjunctival scarring, pterygium, or pinguecula nodosa; current ocular infection or inflammation unrelated to dry eye; clinically significant anterior (epithelial) basement membrane corneal dystrophy or other clinically significant corneal dystrophy or degeneration; clinically significant blepharitis; ocular herpetic infection, etc.

• Known allergy to any procedural reagents or materials in the investigational drug that come into contact with the nasal mucosa.

• Active or uncontrolled severe systemic allergies, chronic seasonal allergies, rhinitis, or sinusitis that require treatment at initial screening (i.e., antihistamines, decongestants, oral or aerosol steroids).

• Currently undergoing any medication therapy known to cause dry eyes (e.g., cyclosporine, antihistamines, tricyclic antidepressants, anxiolytics, antimuscarinic agents, beta-blockers, diuretics, phenothiazines, steroids, etc.), and not using the medication according to a stable dosing regimen for 30 days prior to the first screening.

• Soluble lacrimal duct embolization (participants with silicone embolization or permanent lacrimal duct obstruction are eligible)

• Active contact lenses may be used unless interrupted at least 7 days before the first screening and during the duration of the study.

• Participated in any clinical trials utilizing new active substances or new devices within the past 3 months.

• Women who are pregnant, planning to become pregnant, or breastfeeding at the start of the study. Urine pregnancy tests will be administered to women of childbearing age.

• Known allergy to or adverse reactions to scutellarin.

• Any unstable or uncontrolled cardiac, pulmonary, renal, oncological, neurological, metabolic, or other systemic conditions that the researchers believe would warrant urgent medical attention during this study. This includes, but is not limited to, cardiac arrhythmias, hypertension, coagulation disorders, kidney failure, and diabetes.

Including/excluding exceptions:

Researchers have the right to exclude any patient from a study when they believe it is in the best interests of the patient.

Minor exceptions to the inclusion/exclusion criteria should be submitted to the sponsor and are expected to be approved for notification to the medical monitor if necessary.

Major exceptions affecting patient safety/rights or data validity will be promptly reported by the investigator to the IRB/EC.

Main results: The design of this study will enable the following measurements regarding OC-03 and tear production:

• Changes in tear production associated with a single dose of OC-03

Secondary results: The design of this study will enable the following measurements regarding OC-03 and tear production:

• Changes in tear production associated with a single dose of the medium

Symptom changes associated with a single dose of OC-03

• Duration of symptom relief associated with a single dose of OC-03

• Symptom changes associated with a single dose of the vehicle

• Duration of symptom relief associated with a single dose of the mediator. In summary, these comparisons will provide valuable information regarding the safety and efficacy of OC-03 in increasing tear production in patients with dry eye disease.

The primary safety endpoint of this study is the correlation between morbidity and adverse events (AEs). Descriptive statistics of adverse events will be provided, along with a description of any serious, unexpected, or drug-related AEs. Nasal passage integrity will be monitored by qualified professionals throughout the study for patient safety.

Study Design: This study is a prospective, single-arm crossover study evaluating the safety and efficacy of OC-03 0.1% nasal spray in participants with moderate to severe dry eye. Up to 30 participants will be enrolled and followed for seven days.

At the initial screening, all eligible participants agreed to discontinue their current use of artificial tears or lubricating eye drops for the duration of the study and were provided with a unit dose of preservative-free artificial tears for use when their dry eye symptoms became unbearable. Empty unit dose vials were collected and counted at each study visit. Patients were advised not to use artificial tears within 30 minutes of nasal application or within 2 hours of the study visit.

On Day 0 of the second screening/study, all eligible participants will be tested for their response to two nasal formulations: OC-03 and a mediator control. Tear production in both eyes will be evaluated using the Jones Hillmer test immediately before and after each intranasal dose. Patients will be randomly assigned to receive the OC-03 and mediator formulations in a manner unknown to both patients and examiners. At least 90 minutes after tear production evaluation, changes in symptoms in response to each of the two nasal formulations will be assessed. Symptom assessment will be conducted using a well-established environmental challenge model, namely the ClimaTears goggle system manufactured by Biocentric Developments, LLC.

After testing on day 0, all patients will receive a bottle of OC-03 to take home and self-administer once daily on days 1 and 6. On day 7, patients will return to the outpatient clinic where their tear production and symptoms will be evaluated again with each nasal preparation used.

Tear evaluation

The ocular surface and tear film will be evaluated in the order shown:

Ocular surface staining – corneal staining using fluorescein

The ocular surface staining using fluorescein and lissamine green will be evaluated and recorded on the case report form using the National Eye Society grading system, in schematic diagrams of five corneal areas and six conjunctival areas for each eye. The case report form (CRF) includes both illustrative and descriptive grading scales (grades 0 to 3).

1. A 1.0 mg sodium fluorescein test strip will be used to evaluate corneal staining.

2. After wetting the end of the test piece with a drop of buffered saline, shake the excess saline into the waste bin by rapidly flicking it.

3. Next, pull down the lower eyelid and gently apply the flat tip of the dye to the lower tarsal conjunctiva, intending to instill a very small volume of dye without inducing reflexive tearing.

4. Instruct the patient to blink naturally several times without forcibly closing their eyelids to distribute the fluorescein.

5. After allowing the fluorescein to remain on the eye for at least one minute, five corneal regions will be graded using a yellow (Wratten #12) barrier filter, along with a cobalt (blue) filter, to maximize fluorescence observation. Slightly lift the upper eyelid to allow grading of the entire corneal surface. To enhance contrast, position the yellow barrier filter in the path of the returning light (rather than in the path of the incident light).

Tear film breakup time (TFBUT)

TFBUT will be evaluated using slit-lamp biopsy according to the following steps:

1. Set the slit lamp to approximately 10x magnification.

2. With the fluorescein fully in place (preferably using a DET test strip), the subject will be asked to stare straight ahead without blinking until informed that this is not necessary. The test should be conducted indoors with no direct airflow over the patient's face.

3. A stopwatch will be used to record the time between the last complete blink and the first appearance of growth micelles that indicate tear film rupture.

Note: If the patient blinks too early before the tear film breaks down, the examiner will continue trying to obtain a reading.

4. Once TFBUT is observed, instruct the patient to blink freely. Then repeat the test a second time on the same eye.

5. If the difference between the first and second readings exceeds two seconds, a third measurement should be performed and recorded.

6. The procedure will then be performed in the other eye.

7. It is recommended to perform TFBUT indoors at a temperature of approximately 18°C and a humidity of approximately 50%.

Ocular surface staining – conjunctival staining using erythromycin green

The ocular surface staining evaluation will be completed using lissamine green conjunctival staining.

1. Moisten the Lissamide Green ophthalmic test strip with buffered saline and apply it to the conjunctiva of the lower eyelid. Carefully instill sufficient dye.

2. After allowing erythromycin green to remain on the eyes for one minute, the six nasal and temporal conjunctival areas will be graded.

3. To classify the temporal region, the subject should be instructed to look towards the nose; to classify the nasal region, the subject should be instructed to look towards the temporal region.

4. The procedure will then be completed in the other eye.

Hilmer Test

During the first screening, a basic Jones-Hilmer test will be performed, followed by a Hillmer test using nasal stimulation with a cotton swab. The Jones-Hilmer test, using a local anesthetic, will be used to evaluate tear production, following these steps:

1. Local anesthetic eye drops, such as 0.5% paracaine hydrochloride or equivalent, should be instilled into the patient's eyes.

2. Instruct the patient to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about one minute, gently remove excess moisture from the lower fornix using a cotton swab applicator.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, instruct the patient to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the patient's face.

6. After five minutes, remove the test strips from both eyes and record the amount of wetting. Attach the test strips to the CRF with tape. Note: If the Hillmer score reaches its maximum before the 5-minute end, the test strips can be removed and the time taken to reach that maximum can be recorded. However, the test strips should not be removed from the contralateral eye until it also reaches its maximum score before the 5-minute end.

7. When performing multiple Hiller tests, new anesthetic eye drops should be added as necessary.

The Hiller test using a cotton swab to stimulate the nose.

1. During the first screening, the Hiller test will be performed using a cotton swab nasal stimulation. With a new swab in place, the examiner will simultaneously insert the swab into both nostrils of the participant and gently probe the two middle turbinates for approximately 30 seconds. Afterward, the examiner may simply keep the swab in place, apply slight pressure, and repeat the probe intermittently as needed.

2. Alternatively, participants can be instructed to hold a cotton swab and gently probe both nasal turbinates simultaneously, taking intermittent breaks before probing again. The examiner will provide ongoing guidance on how to properly perform the test.

3. Keep the Hilmer test film in place until five minutes have passed or it has reached its maximum score.

Two Hillmer scores will be recorded and their compliance with inclusion criteria will be verified. New anesthetic eye drops should be administered if necessary during both Hillmer tests.

Hillmer tests were conducted on each of the two nasal spray applications.

Using each of the two nasal spray applications, the Jones-Hilmer test using a local anesthetic will be used to evaluate tear production, following the steps below:

1. For each application, administer local anesthetic eye drops, such as 0.5% paracaine hydrochloride or an equivalent, into the participant's eyes.

2. Participants will be instructed to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about a minute, gently remove excess water from the lower fornix with a small fork.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, participants will be instructed to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the participant's face.

6. After five minutes, the test strip will be removed from both eyes and the amount of wetting will be recorded. The test strip will then be taped to the CRF.

Dry eye irritation and symptom evaluation

The ClimaTears goggle system (Biocentric Developments, LLC) will be used to reduce periocular humidity and induce dry eye symptoms in patients. This system is designed for the purpose of standardizing testing conditions in clinical studies of dry eye patients.

Patients will wear ClimaTears goggles continuously for up to 90 minutes, recording their symptoms every 5 minutes during the test period using a Visual Analogue Scale (VAS). Subjects will be asked to rate their dryness symptoms (both eyes, simultaneously) by placing vertical markers on a horizontal line to indicate the level of discomfort. 0 corresponds to "no dryness," and 5 corresponds to "maximum dryness." The rating line length will be 100 mm (Figure 3).

On Day 0, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45mm or higher. At this point, they will be randomly assigned to receive either a dose of OC-03 nasal spray or a control nasal spray, administered 2.5 minutes after two consecutive 45mm measurements. Symptom monitoring will continue until the patient again reaches a score of 45mm or higher. At this point, the patient will receive a second nasal dose of any test item not received on the first attempt. After the second nasal dose, symptoms will be monitored again until the patient reaches a score of 45mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles. At the end of this period, each patient will be asked to indicate which nasal spray provided the greatest relief for their dry eye symptoms.

On day 7, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45 mm or higher. At this point, they will receive one dose of OC-03 nasal spray. Symptom monitoring will continue until the patient again has two consecutive measurements reaching a score of 45 mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles.

Patients with a baseline symptom score greater than 45 mm upon admission will have a treatment threshold equal to that baseline score and will therefore be treated after having two consecutive symptom measurements greater than or equal to that value.

Before the test begins and immediately after administering any nasal spray, before recording symptom values, read the instructions (in bold above) to the patient.

Example 1d: Clinical trial evaluating the safety and efficacy of nasal administration of the nicotinic acetylcholine receptor agonist tebuclam for the treatment of dry eye disease (DED).

Objective: This study evaluated the use of tebuconazole 0.1% nasal spray (OC-04) in the treatment of moderate to severe dementia (DED) in adult patients. The study investigated the safety and efficacy of OC-04 in inducing aqueous tear production and alleviating DED symptoms.

Patients: A total of 30 participants with moderate to severe dry eye who meet the following inclusion and exclusion criteria will be enrolled.

Guidelines:

Included:

• Males and females aged 18 and above

• Willing to sign informed consent form and deemed able to comply with the requirements of the research protocol.

• At the first screening, the Hiller tear test (using local anesthesia) of at least one eye should be ≤10mm/5min;

• At the first screening, the Hiller test (using local anesthesia and nasal stimulation with a cotton swab) in at least one eye was at least 7 mm higher than the value in the unstimulated eye;

• A baseline ocular surface disease index score of at least 23, with no more than 3 "not applicable" responses at the first screening.

Normal eyelid/eyelash anatomy, blinking function, and closure.

exclude:

Chronic or recurrent nosebleeds

• Use of tobacco or nicotine products (cigarettes, cigars, e-cigarettes) within the past year

• Coagulation disorders that may increase bleeding, such as hemophilia and thrombocytopenia.

• Formation of a tumor in the lacrimal gland, nose, or sinus, or major trauma; previous surgery or removal of the lacrimal gland, nose, or sinus, resulting in denervation of the gland or nasal passage, as demonstrated by a lack of response to nasal stimulation with a cotton swab.

• Severe nasal airway obstruction (e.g., severe nasal septum deviation or inferior turbinate hypertrophy)

• Underwent eye surgery (such as refractive surgery or cataract surgery) in either eye within 3 months of the first screening;

• Unstable or systemic conditions or diseases deemed incompatible with participation in the study by the investigator (e.g., current systemic infection, uncontrolled autoimmune disease, uncontrolled immunodeficiency, history of myocardial infarction, uncontrolled hypertension, etc.) or incompatible with the frequent evaluations required for the study.

• The history or presence of any ocular condition or symptom in either eye that could potentially interfere with the interpretation of research results or patient safety, such as significant corneal or conjunctival scarring, pterygium, or pinguecula nodosa; current ocular infection or inflammation unrelated to dry eye; clinically significant anterior (epithelial) basement membrane corneal dystrophy or other clinically significant corneal dystrophy or degeneration; clinically significant blepharitis; ocular herpetic infection, etc.

• Known allergy to any procedural reagents or materials in the investigational drug that come into contact with the nasal mucosa.

• Active or uncontrolled severe systemic allergies, chronic seasonal allergies, rhinitis, or sinusitis that require treatment at initial screening (i.e., antihistamines, decongestants, oral or aerosol steroids).

• Currently undergoing any medication therapy known to cause dry eyes (e.g., cyclosporine, antihistamines, tricyclic antidepressants, anxiolytics, antimuscarinic agents, beta-blockers, diuretics, phenothiazines, steroids, etc.), and not using the medication according to a stable dosing regimen for 30 days prior to the first screening.

• Soluble lacrimal duct embolization (participants with silicone embolization or permanent lacrimal duct obstruction are eligible)

• Active contact lenses should not be used unless interrupted for at least 7 days prior to the first screening and during the duration of the study.

• Participated in any clinical trials utilizing new active substances or new devices within the past 3 months.

• Women who are pregnant, planning to become pregnant, or breastfeeding at the start of the study. Urine pregnancy tests will be administered to women of childbearing age.

• Known allergy to tebecline or adverse reactions

• Any unstable or uncontrolled cardiac, pulmonary, renal, oncological, neurological, metabolic, or other systemic conditions that the researchers believe would warrant urgent medical attention during this study. This includes, but is not limited to, cardiac arrhythmias, hypertension, coagulation disorders, kidney failure, and diabetes.

Including/excluding exceptions:

Researchers have the right to exclude any patient from a study when they believe it is in the best interests of the patient.

Minor exceptions to the inclusion/exclusion criteria should be submitted to the sponsor and are expected to be approved for notification to the medical monitor if necessary.

Major exceptions affecting patient safety/rights or data validity will be promptly reported by the investigator to the IRB/EC.

Main results: The design of this study will enable the following measurements regarding OC-04 and tear production:

• Changes in tear production associated with a single dose of OC-04

Secondary results: The design of this study will enable the following measurements regarding OC-04 and tear production:

• Changes in tear production associated with a single dose of the medium

Symptom changes associated with a single dose of OC-04

Duration of symptom relief associated with a single dose of OC-04

• Symptom changes associated with a single dose of the vehicle

Duration of symptom relief associated with a single dose of the drug

In summary, these comparisons will provide valuable information regarding the safety and efficacy of OC-04 in increasing tear production in patients with dry eye disease.

The primary safety endpoint of this study is the correlation between morbidity and adverse events (AEs). Descriptive statistics of adverse events will be provided, along with a description of any serious, unexpected, or drug-related AEs. Nasal passage integrity will be monitored by qualified professionals throughout the study for patient safety.

Study Design: This is a prospective, single-arm crossover study evaluating the safety and efficacy of OC-04 tebuclam 0.1% nasal spray in participants with moderate to severe dry eye. Up to 30 participants will be enrolled and followed for seven days.

At the initial screening, all eligible participants agreed to discontinue their current use of artificial tears or lubricating eye drops for the duration of the study and were provided with a unit dose of preservative-free artificial tears for use when their dry eye symptoms became unbearable. Empty unit dose vials were collected and counted at each study visit. Patients were advised not to use artificial tears within 30 minutes of nasal application or within 2 hours of the study visit.

On Day 0 of the second screening/study, all eligible participants will be tested for their response to two nasal formulations: OC-04 and a mediator control. Tear production in both eyes will be evaluated using the Jones Hillmer test immediately before and after each intranasal dose. Patients will be randomly assigned to receive the OC-04 and mediator formulations in a manner unknown to both patients and examiners. At least 90 minutes after tear production evaluation, changes in symptoms in response to each of the two nasal formulations will be assessed. Symptom assessment will be conducted using a well-established environmental challenge model, namely the ClimaTears goggle system manufactured by Biocentric Developments, LLC.

After testing on day 0, all patients will receive a bottle of OC-04 to take home and self-administer once daily on days 1 and 6. On day 7, patients will return to the outpatient clinic for a further evaluation of their tear production and symptoms with each nasal preparation used.

Tear evaluation

The ocular surface and tear film will be evaluated in the order shown:

Ocular surface staining – corneal staining using fluorescein

The ocular surface staining using fluorescein and lissamine green will be evaluated and recorded on the case report form using the National Eye Society grading system, in schematic diagrams of five corneal areas and six conjunctival areas for each eye. The case report form (CRF) includes both illustrative and descriptive grading scales (grades 0 to 3).

1. A 1.0 mg sodium fluorescein test strip will be used to evaluate corneal staining.

2. After wetting the end of the test piece with a drop of buffered saline, shake the excess saline into the waste bin by rapidly flicking it.

3. Next, pull down the lower eyelid and gently apply the flat tip of the dye to the lower tarsal conjunctiva, intending to instill a very small volume of dye without inducing reflexive tearing.

4. Instruct the patient to blink naturally several times without forcibly closing their eyelids to distribute the fluorescein.

5. After allowing the fluorescein to remain on the eye for at least one minute, five corneal regions will be graded using a yellow (Wratten #12) barrier filter, along with a cobalt (blue) filter, to maximize fluorescence observation. Slightly lift the upper eyelid to allow grading of the entire corneal surface. To enhance contrast, position the yellow barrier filter in the path of the returning light (rather than in the path of the incident light).

Tear film breakup time (TFBUT)

TFBUT will be evaluated using slit-lamp biopsy according to the following steps:

1. Set the slit lamp to approximately 10x magnification.

2. With the fluorescein fully in place (preferably using a DET test strip), the subject will be asked to stare straight ahead without blinking until informed that this is not necessary. The test should be conducted indoors with no direct airflow over the patient's face.

3. A stopwatch will be used to record the time between the last complete blink and the first appearance of growth micelles that indicate tear film rupture.

Note: If the patient blinks too early before the tear film breaks down, the examiner will continue trying to obtain a reading.

4. Once TFBUT is observed, instruct the patient to blink freely. Then repeat the test a second time on the same eye.

5. If the difference between the first and second readings exceeds two seconds, a third measurement should be performed and recorded.

6. The procedure will then be performed in the other eye.

7. It is recommended to perform TFBUT indoors at a temperature of approximately 18°C and a humidity of approximately 50%.

Ocular surface staining – conjunctival staining using erythromycin green

The ocular surface staining evaluation will be completed using lissamine green conjunctival staining.

1. Moisten the Lissamide Green ophthalmic test strip with buffered saline and apply it to the conjunctiva of the lower eyelid. Carefully instill sufficient dye.

2. After allowing erythromycin green to remain on the eyes for one minute, the six nasal and temporal conjunctival areas will be graded.

3. To classify the temporal region, the subject should be instructed to look towards the nose; to classify the nasal region, the subject should be instructed to look towards the temporal region.

4. The procedure will then be completed in the other eye.

Hilmer Test

During the first screening, a basic Jones-Hilmer test will be performed, followed by a Hillmer test using nasal stimulation with a cotton swab. The Jones-Hilmer test, using a local anesthetic, will be used to evaluate tear production, following these steps:

1. Local anesthetic eye drops, such as 0.5% paracaine hydrochloride or equivalent, should be instilled into the patient's eyes.

2. Instruct the patient to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about one minute, gently remove excess moisture from the lower fornix using a cotton swab applicator.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, instruct the patient to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the patient's face.

6. After five minutes, remove the test strips from both eyes and record the amount of wetting. Attach the test strips to the CRF with tape. Note: If the Hillmer score reaches its maximum before the 5-minute end, the test strips can be removed and the time taken to reach that maximum can be recorded. However, the test strips should not be removed from the contralateral eye until it also reaches its maximum score before the 5-minute end.

7. When performing multiple Hiller tests, new anesthetic eye drops should be added as necessary.

The Hiller test using a cotton swab to stimulate the nose.

1. During the first screening, the Hiller test will be performed using a cotton swab nasal stimulation. With a new swab in place, the examiner will simultaneously insert the swab into both nostrils of the participant and gently probe the two middle turbinates for approximately 30 seconds. Afterward, the examiner may simply keep the swab in place, apply slight pressure, and repeat the probe intermittently as needed.

2. Alternatively, participants can be instructed to hold a cotton swab and gently probe both nasal turbinates simultaneously, taking intermittent breaks before probing again. The examiner will provide ongoing guidance on how to properly perform the test.

3. Keep the Hilmer test film in place until five minutes have passed or it has reached its maximum score.

Two Hillmer scores will be recorded and their compliance with inclusion criteria will be verified. New anesthetic eye drops should be administered if necessary during both Hillmer tests.

Hillmer tests were conducted on each of the two nasal spray applications.

Using each of the two nasal spray applications, the Jones-Hilmer test using a local anesthetic will be used to evaluate tear production, following the steps below:

1. For each application, administer local anesthetic eye drops, such as 0.5% paracaine hydrochloride or an equivalent, into the participant's eyes.

2. Participants will be instructed to keep their eyes gently closed for one minute.

3. After opening your eyes and allowing them to close again for about a minute, gently remove excess water from the lower fornix with a small fork.

4. Place the Hillmer test strip (35mm×5mm filter paper test strip) at the junction of the middle third and the lateral third of the lower eyelid of each eye.

5. Under ambient light, participants will be instructed to look straight ahead and blink normally during the test. The test should be conducted indoors with no direct airflow over the participant's face.

6. After five minutes, the test strip will be removed from both eyes and the amount of wetting will be recorded. The test strip will then be taped to the CRF.

Dry eye irritation and symptom evaluation

The ClimaTears goggle system (Biocentric Developments, LLC) will be used to reduce periocular humidity and induce dry eye symptoms in patients. This system is designed for the purpose of standardizing testing conditions in clinical studies of dry eye patients.

Patients will wear ClimaTears goggles continuously for up to 90 minutes, recording their symptoms every 5 minutes during the test period using a Visual Analogue Scale (VAS). Subjects will be asked to rate their dryness symptoms (both eyes, simultaneously) by placing vertical markers on a horizontal line to indicate the level of discomfort. 0 corresponds to "no dryness," and 5 corresponds to "maximum dryness." The rating line length will be 100 mm (Figure 3).

On Day 0, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45mm or higher. At this point, they will be randomly assigned to receive either a dose of OC-04 nasal spray or a control nasal spray, administered 2.5 minutes after two consecutive 45mm measurements. Symptom monitoring will continue until the patient again reaches a score of 45mm or higher. At this point, the patient will receive a second nasal dose of any test item not received on the first attempt. After the second nasal dose, symptoms will be monitored again until the patient reaches a score of 45mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles. At the end of this period, each patient will be asked to indicate which nasal spray provided the greatest relief for their dry eye symptoms.

On day 7, patients will begin wearing goggles and be monitored until two consecutive measurements reach a symptom score of 45 mm or higher. At this point, they will receive one dose of OC-04 nasal spray. Symptom monitoring will continue until the patient again has two consecutive measurements reaching a score of 45 mm or higher. At this point, the goggles will be removed and the test will end. If continued, the test will be terminated 90 minutes after exposure to the goggles.

Patients with a baseline symptom score greater than 45 mm upon admission will have a treatment threshold equal to that baseline score and will therefore be treated after having two consecutive symptom measurements greater than or equal to that value.

Before the test begins and immediately after administering any nasal spray, before recording symptom values, read the instructions (in bold above) to the patient.

Example 2: OC-01 formulation

OC-01 contains 0.1% valencrine in preservative-free sterile phosphate-buffered saline (PBS) consisting of 137 mM sodium chloride, 2.7 mM potassium chloride, and 10 mM phosphate buffer at pH 7.4. The formulation is packaged in a 20 mL opaque polyethylene nasal spray bottle, thereby delivering a 50 μL unit dose. A media control was supplied in the same packaging. Both OC-01 and the media control are labeled with codes indicating the contents of the package so that participants or uninformed researchers are unaware of the contents.

Example 3: Other pharmaceutical preparations

To prepare a pharmaceutical formulation suitable for nasal administration, 10 mg of nicotinic acetylcholine receptor agonist was dissolved in 10 mL of a specified medium. 1 mL of this solution was diluted in 9 mL of the medium to obtain a "0.1X dilution" formulation. After the first dilution, 1 mL of the "0.1X dilution" formulation was diluted in 9 mL of the medium to obtain a "0.01X dilution" formulation. The three formulations, containing different concentrations of nicotinic acetylcholine receptor agonist, were stored at 4°C.

Although preferred embodiments of the invention have been shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided by way of example only. Numerous changes, variations, and substitutions will occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein can be used to implement the invention. The following technical solutions are intended to define the scope of the invention and thus encompass the methods and structures within the scope of these technical solutions and their equivalents.

In summary, the present invention includes, but is not limited to, the following technical solutions:

1. A method for increasing tear production, comprising topically applying a therapeutically effective amount of a nicotinic acetylcholine receptor agonist to the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors.

2. A method for treating dry eye, comprising topically applying a therapeutically effective amount of a nicotinic acetylcholine receptor agonist into the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors.

3. A method for improving eye discomfort, comprising topically applying a therapeutically effective amount of a nicotinic acetylcholine receptor agonist to the nasal cavity of an individual in need, wherein the agonist selectively binds to peripheral nicotinic acetylcholine receptors.

4. The method of any one of items 1 to 3, wherein the agonist does not cross the blood-brain barrier at a pharmacologically relevant concentration.

5. The method of any one of claims 1 to 4, wherein the agonist selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2 and α7.

6. The method of any one of claims 1 to 5, wherein the agonist is administered in an amount that is not systemically bioavailable.

7. The method of any one of claims 1 to 6, wherein the agonist selectively binds to the peripheral nicotinic acetylcholine receptor in an amount that does not cause unwanted psychological side effects.

8. The method of any one of claims 1 to 7, wherein the agonist selectively binds to the peripheral nicotinic acetylcholine receptor in an amount that does not cause unwanted systemic side effects.

9. The method of any one of claims 1 to 8, further comprising the local application of one or more substances that prevent or reduce nicotinic acetylcholine receptors from entering a desensitized state or promote the recovery of nicotinic acetylcholine receptors from a desensitized state.

10. The method of claim 9, wherein the one or more substances are selected from protein kinase C (PKC) or a factor that upregulates or upregulates PKC, cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA, and calcineurin inhibitors.

11. The method of claim 10, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus.

12. The method of any one of claims 1 to 11, wherein the nicotinic acetylcholine receptor agonist is selected from cytisine, scutellarin, varenclin, tebuclam, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380.

13. The method of any one of claims 1 to 12, wherein at least 5 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity.

14. The method of any one of claims 1 to 12, wherein at least 100 micrograms of the nicotinic acetylcholine receptor agonist is administered into the nasal cavity.

15. The method of any one of claims 1 to 14, wherein the nicotinic acetylcholine receptor agonist is administered at least once daily.

16. The method of any one of claims 1 to 14, wherein the nicotinic acetylcholine receptor agonist is administered at least twice daily.

17. The method of any one of items 1 to 14, wherein the nicotinic acetylcholine receptor agonist is administered at least once a week.

18. The method of any one of claims 1 to 17, wherein the nicotinic acetylcholine receptor agonist is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm.

19. The method of any one of claims 1 to 18, wherein the nicotinic acetylcholine receptor agonist is administered into the nasal cavity via a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette or liquid injector.

20. The method of any one of items 1 to 19, wherein the trigeminal nerve is activated.

21. The method as described in item 20, wherein the anterior ethmoidal nerve is activated.

22. The method of any one of items 1 to 21, wherein the nasolacrimal reflex is activated.

23. A pharmaceutical preparation for topical application to an individual's nasal cavity, comprising a nicotinic acetylcholine receptor agonist formulated (a) for nasal administration and (b) to prevent desensitization.

24. The pharmaceutical formulation of claim 23, wherein the nicotinic acetylcholine receptor agonist is formulated in an amount that will not cause unwanted psychogenic side effects.

25. The pharmaceutical formulation of claim 23 or 24, wherein the nicotinic acetylcholine receptor agonist is formulated in an amount that does not have systemic bioavailability.

26. The pharmaceutical preparation of any one of claims 23 to 25, wherein the nicotinic acetylcholine receptor agonist is formulated in an amount that will not cause unwanted systemic side effects.

27. The pharmaceutical preparation of any one of items 23 to 26, further comprising one or more substances selected from protein kinase C (PKC) or a factor that upregulates or upregulates PKC, cAMP-dependent protein kinase (PKA) or a factor that upregulates or upregulates PKA, and calcineurin inhibitors.

28. The pharmaceutical formulation of claim 27, wherein the calcineurin inhibitor is selected from cyclosporine, pimecrolimus, and tacrolimus.

29. The pharmaceutical preparation of any one of claims 23 to 28, wherein the nicotinic acetylcholine receptor agonist is selected from cytisine, scutellarin, varenclin, tebuconazole, DBO-83, CC4, ABT-418, ABT-366833, ABT-202, ABT-894, SIB-1663, GTS-21, PHA-543613, PNU-282987, LY-2087101, A85380, and 5-I-A85380.

30. The pharmaceutical formulation of any one of claims 23 to 29, wherein the nicotinic acetylcholine receptor agonist selectively binds to at least one of the peripheral nicotinic acetylcholine receptor subtypes selected from α3β4, α4β2 and α7.

31. The pharmaceutical preparation of any one of claims 23 to 30, wherein the pharmaceutical preparation comprises about 1 mg/mL of the nicotinic acetylcholine receptor agonist.

32. The pharmaceutical formulation of any one of claims 23 to 30, wherein the pharmaceutical formulation comprises about 10 mg/mL of the nicotinic acetylcholine receptor agonist.

33. The pharmaceutical preparation of any one of items 23 to 30, comprising at least 5 micrograms of the nicotinic acetylcholine receptor agonist per dose.

34. The pharmaceutical preparation of any one of items 23 to 30, comprising at least 50 micrograms of the nicotinic acetylcholine receptor agonist per dose.

35. The pharmaceutical preparation of any one of claims 23 to 30, comprising at least 100 micrograms of the nicotinic acetylcholine receptor agonist per dose.

36. The pharmaceutical preparation of any one of claims 23 to 30, comprising at least 500 micrograms of the nicotinic acetylcholine receptor agonist per dose.

37. The pharmaceutical preparation of any one of items 23 to 30, comprising the nicotinic acetylcholine receptor agonist at doses between 5 micrograms and 1 gram.

38. The pharmaceutical preparation of any one of items 23 to 37, wherein the preparation is administered at least once a day.

39. The pharmaceutical preparation of any one of items 23 to 37, wherein the preparation is administered at least twice daily.

40. A pharmaceutical preparation as described in any one of items 23 to 37, wherein the preparation is applied at least once a week.

41. The pharmaceutical preparation of any one of claims 23 to 40, wherein the preparation is applied to the nasal cavity in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, or balm.

42. The pharmaceutical preparation of any one of claims 23 to 41, wherein the preparation is administered into the nasal cavity by means of a syringe, dropper, bottle nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette or liquid injector.

Claims (49)

1. Use of varenclin or a pharmaceutically acceptable salt thereof in the preparation of a medicament for a method of increasing the amount or concentration of one or more tear proteins produced by an individual to treat dry eye disease, characterized in that the medicament is for nasal administration and each dose contains 5 micrograms to 1000 micrograms of varenclin. 2. The use according to claim 1, wherein the one or more tear proteins are selected from epidermal growth factor, lactoferrin, lacrimal protein, prolactin, adrenocorticotropic hormone, leucine enkephalin, ALS2CL, ARHGEF19, KIAA1109, PLXNA1, POLG, WIPI1, ZMIZ2 or other proteins of the tear proteome. 3. The use according to any one of claims 1 to 2, wherein the individual has one or more of the following symptoms, including itching, dryness, photophobia, blurred vision, pain, stickiness, burning, stinging, and foreign body sensation. 4. The use according to any one of claims 1 to 2, wherein the individual has a Hillmer tear test score of <10 mm/5 min in at least one eye prior to the application of varenclin. 5. The use according to claim 4, wherein the Hillmer tear test is performed under local anesthesia. 6. The use according to any one of claims 1 to 2, wherein the individual will undergo or has undergone LASIK eye surgery. 7. The use according to any one of claims 1 to 2, wherein each nasal dose of the drug contains 5 to 100 micrograms of varencrine. 8. The use according to any one of claims 1 to 2, wherein each nasal dose of the drug comprises 5 micrograms to 600 micrograms of varencrine. 9. The use according to any one of claims 1 to 2, wherein each nasal dose of the drug comprises 100 micrograms to 750 micrograms of valenclin. 10. The use according to claim 3, wherein each nasal dose of the drug comprises 5 to 100 micrograms of varencrine. 11. The use according to claim 3, wherein each nasal dose of the drug comprises 100 micrograms to 750 micrograms of varencrine. 12. The use according to any one of claims 1 to 2, wherein the drug does not contain preservatives. 13. The use according to claim 10, wherein the drug does not contain preservatives. 14. The use according to claim 11, wherein the drug does not contain preservatives. 15. The use according to any one of claims 1 to 2, wherein the substance comprises one or more preservatives. 16. The use according to any one of claims 1 to 2, wherein the drug comprises about 0.1 mg/mL of varenclin or a pharmaceutically acceptable salt thereof. 17. The use according to any one of claims 1 to 2, wherein the drug comprises about 0.2 mg/mL of varenclin or a pharmaceutically acceptable salt thereof. 18. The use according to any one of claims 1 to 2, wherein the drug comprises about 0.5 mg/mL, about 1 mg/mL, about 2 mg/mL, about 3 mg/mL, about 4 mg/mL, about 5 mg/mL, about 6 mg/mL, about 7 mg/mL, about 8 mg/mL, about 9 mg/mL, about 10 mg/mL, about 15 mg/mL, or about 20 mg/mL of varenclin or a pharmaceutically acceptable salt thereof. 19. The use according to any one of claims 1 to 2, wherein the varenclin or a pharmaceutically acceptable salt thereof is administered at least once a day, at least twice a day, or at least once a week. 20. The use according to any one of claims 1 to 2, wherein the varenclin or a pharmaceutically acceptable salt thereof is applied in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, balm, or nasal spray. 21. The use according to any one of claims 1 to 2, wherein the varenclin or a pharmaceutically acceptable salt thereof is administered via a syringe, dropper, nebulizer, nebulizer pump, inhaler, powder sprayer, vaporizer, patch, applicator stick, pipette, liquid injector or nasal spray bottle. 22. The use according to any one of claims 1 to 2, wherein the administration of the varencrine or a pharmaceutically acceptable salt thereof is combined with the use of a medical device. 23. The use according to any one of claims 1 to 2, wherein the varencrine or a pharmaceutically acceptable salt thereof is administered in an amount that will not cause unwanted systemic side effects. 24. The use according to any one of claims 1 to 2, wherein the drug is used to treat eye discomfort. 25. The use according to any one of claims 1 to 2, wherein the drug increases tear production. 26. A nasal pharmaceutical preparation comprising varencrine or a pharmaceutically acceptable salt thereof, provided per dose in an amount between 5 micrograms and 1000 micrograms, in a method of treating dry eye disease by increasing the amount or concentration of one or more tear proteins produced by an individual. 27. The pharmaceutical formulation according to claim 26, wherein the one or more tear proteins are selected from epidermal growth factor, lactoferrin, lacrimal protein, prolactin, adrenocorticotropic hormone, leucine enkephalin, ALS2CL, ARHGEF19, KIAA1109, PLXNA1, POLG, WIPI1, ZMIZ2, or other proteins of the tear proteome. 28. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the individual has one or more of the following symptoms, including itching, dryness, photophobia, blurred vision, pain, stickiness, burning, stinging, and foreign body sensation. 29. The pharmaceutical formulation according to any one of claims 26 to 27, wherein the individual had a Hillmer tear test score of <10 mm/5 min in at least one eye prior to administration of varenclin. 30. The pharmaceutical formulation of claim 29, wherein the Hillmer tear test is performed under local anesthesia. 31. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the individual will undergo or has undergone LASIK eye surgery. 32. The pharmaceutical formulation according to any one of claims 26 to 27, wherein the amount of varenclin or a pharmaceutically acceptable salt thereof is provided in an amount between 5 micrograms and 100 micrograms per dose. 33. The pharmaceutical formulation according to any one of claims 26 to 27, wherein the amount of varenclin or a pharmaceutically acceptable salt thereof is provided in an amount between 5 micrograms and 600 micrograms per dose. 34. The pharmaceutical formulation according to any one of claims 26 to 27, wherein the amount of varenclin or a pharmaceutically acceptable salt thereof is provided in an amount between 100 micrograms and 750 micrograms per dose. 35. The pharmaceutical formulation of claim 28, wherein the amount of varenclin or a pharmaceutically acceptable salt thereof is provided in a dose between 5 micrograms and 100 micrograms of varenclin. 36. The pharmaceutical formulation of claim 28, wherein the amount of varenclin or a pharmaceutically acceptable salt thereof is provided in a dose between 100 micrograms and 750 micrograms of varenclin. 37. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation is free of preservatives. 38. The pharmaceutical preparation of claim 35, wherein the pharmaceutical preparation is free of preservatives. 39. The pharmaceutical preparation of claim 36, wherein the pharmaceutical preparation is free of preservatives. 40. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation comprises one or more preservatives. 41. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation comprises about 0.1 mg/mL of varencrine or a pharmaceutically acceptable salt thereof. 42. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation comprises about 0.2 mg/mL of varencrine or a pharmaceutically acceptable salt thereof. 43. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation comprises about 0.5 mg/mL, about 1 mg/mL, about 2 mg/mL, about 3 mg/mL, about 4 mg/mL, about 5 mg/mL, about 6 mg/mL, about 7 mg/mL, about 8 mg/mL, about 9 mg/mL, about 10 mg/mL, about 15 mg/mL, or about 20 mg/mL of varenclin or a pharmaceutically acceptable salt thereof. 44. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation is administered at least once a day, at least twice a day, or at least once a week. 45. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation is applied in the form of a liquid, suspension, aerosol, gel, ointment, dry powder, cream, paste, lotion, balm, or nasal spray. 46. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation is administered by a syringe, dropper, bottle nebulizer, nebulizing pump, inhaler, powder spraying device, vaporizer, patch, applicator stick, pipette, liquid injector or nasal spray bottle. 47. The pharmaceutical preparation according to any one of claims 26 to 27, wherein administration of the pharmaceutical preparation is combined with the use of a medical device. 48. The pharmaceutical preparation according to any one of claims 26 to 27, wherein the pharmaceutical preparation is administered in an amount that will not cause unwanted systemic side effects. 49. Use of the pharmaceutical preparation according to any one of claims 26 to 27 in the preparation of a medicament for treating dry eye.