Altacor has three areas of therapeutic interest

Dry Eye Syndrome

(Keratitis sicca, or keratoconjuncticitis sicca)

Dry Eye syndrome has two main causes - firstly, a reduction in the quantity of tears themselves and secondly poor quality tear film, both factors may be implicated in the condition. Tears are complex and composed of three layers. The mucin layer coats the cornea, forming a foundation so the tear film can be spread during the blinking process over the surface of the eye with minimal friction. The central, aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer consists of 98 percent water along with small amounts of salt, proteins and other compounds. The outer lipid layer seals the tear film and helps to prevent evaporation. Tears are formed in several glands around the eye.

There are several possible reasons for the development of dry eye. It is often associated with ageing however, there are also several diseases which can trigger it, for example certain types of arthritis, and Sjogren’s syndrome. Typically eyes feel irritated, scratchy, and dry. This may be present all day but can be worse first thing in the morning and in certain prevailing livingl conditions. The most frequent treatments are lubricating eye drops or gels. These do not cure dry eye but help relieve the symptoms.

Ocular Infection

Ocular infections are very common, but the true incidence is hard to estimate as many patients are treated empirically by their family doctors or the local pharmacist. The most common pathogens are bacterial, but infections can be of viral, fungal or protozoan origin. In the absence of surgery or trauma, infections within the eye ball are rare: the overwhelming majority of infections affect the ocular surface only.

Bacterial infections of the ocular surface can range from a self limiting, relatively minor bacterial conjunctivitis to sight threatening diseases. Several species of bacteria can cause conjunctivitis. There is no reliable clinical method of distinguishing those infections which will prove to be benign from those that lead to a serious complication until it becomes apparent that the response to treatment is inadequate. By this time permanent damage may have already occurred.

Ideally, a conjunctival swab and/or corneal scrape is taken and sent without delay to the laboratory for culture and sensitivity of the relevant organism. This is not a practical consideration in routine practice. The use of an antibiotic is recommended even in the self limiting bacterialconjunctivitis as this leads to early resolution of symptoms and reduces the risk of infecting other contacts such as family members or class mates.

For this reason, a safe ‘Best Guess’ antibiotic is used – one that is most likely to be effective against the most important pathogens – without any sample testing. In most cases, treatment with topical antibiotics is successful. However, drug resistance is a constant threat and infections with MRSA have been reported.

Moreover, none of the currently available antibiotics for ocular use cover viral, fungal or parasitic infections. Adenoviral infections cause significant ocular discomfort, often in both eyes, and can spread very quickly to contacts. Infections with fungi or a canthamoeba are especially difficult to diagnose and treat effectively, and often lead to permanent scarring of the cornea and subsequent vision loss. Although, there is a good choice of antimicrobial products for ocular use, none offer a broad enough spectrum of activity to protect the eye from resistant bacteria or from infections of a non-bacterial origin. This continues to be an unmet medical need.

Glaucoma

Glaucoma is the name given to a group of eye conditions in which the optic nerve is slowly damaged. Glaucoma is often associated with increased intraocular pressure (IOP), but not in all patients. Untreated elevated IOP causes irreversible damage to the optic nerve and loss of retinal fibres resulting in a typical pattern of visual fields loss which is progressive and permanent. Initially, this is only noticeable using special tests, but if allowed to progress, it can lead to “tunnel vision” and ultimately loss of vision. Early detection through routine screening and subsequent treatment can significantly reduce or eliminate the disease progression so that complete blindness occurs only in a very small proportion of patients.

Most types of glaucoma cannot be cured. Patients need to be checked routinely and use medication every day. Treatment is usually with eye drops containing prostaglandins or beta blockers which will reduce the IOP to a level that is low enough to prevent further loss of field of vision. If eye drops alone are not enough, surgery can be considered. The management of glaucoma is tailored to best suit the individual patient and requires specialist attention.