Infection. In most cases, this restricts the use of topical steroids for serious symptoms and/or only for acute therapy of dry eye exacerbations. Considering the fact that there is no data displaying that larger potency corticosteroids are preferred to reduce potency “soft” steroids, as well as the latter possess a more acceptable security profile, weaker and/or dilute corticosteroids are advised for use. Lately, loteprednol etabonate, an ester corticosteroid with anti-inflammatory efficacy and improved safety compared with other corticosteroids (Loteprednol Etabonate US Uveitis Study Group, 1999) was employed in dry eye patients. Pflugfelder et al. (2004) demonstrated that loteprednol etabonate-treated patients had substantial improvement in inferior tarsal and nasal bulbar conjunctival hyperemia devoid of the clinically substantial improve in intraocular stress over the placebo-treated individuals. 1 point that needs emphasis is that response to corticosteroid therapy is far Bcl-xL Modulator Accession faster than response to cyclosporine therapy; as a result, `pulse therapy’ with corticosteroids could be expected to show leads to a brief time frame. A promising novel therapeutic approach is primarily based on selective glucocorticoid receptor agonists (SEGRAs). SEGRAs represent a novel class of compounds that regulate glucocorticoid receptor-mediated gene expression by means of repression carrying out antiinflammatory activities with JAK2 Inhibitor Source reportedly decreased unwanted side effects as compared to classical steroids (Rosen and Miner, 2005). In vitro data recommend that mapracorat, a SEGRA compound, inhibits hyperosmolarity-induced pro-inflammatory cytokines IL-6, IL-8, and MCP-1 in human corneal epithelial cells with comparable efficacy and potency as dexamethasone (Cavet et al., 2010); having said that, the clinical utility of these SEGRA agents must be definitively demonstrated in prospective randomized trials. four.3 Tetracyclines Tetracyclines are antibiotics that interfere with protein synthesis at the ribosomal amount of several gram-positive and gram-negative bacteria, mycoplasms, chlamydiae, and spirochetes. Among these, tetracycline is really a cost-effective agent. Even so, on account of its short half-life (eight.five hours), tetracycline requires a regimen of 4 times per day. In contrast, doxycycline and minocycline possess a a great deal longer half-life (157 hours), which permits a each day dosage of one tablet. Tetracyclines are excreted within the urine except for doxycycline, which is excretedProg Retin Eye Res. Author manuscript; readily available in PMC 2013 May 01.Barabino et al.Pageprimarily inside the feces. Hence, doxycycline is regarded as the tetracycline of option for patients with renal failure.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptRecently, tetracyclines have been identified in possession of a lot of anti-inflammatory properties, which includes inhibition of matrix metalloproteinase (MMP) activity (Ryan et al., 2001; Smith et al., 1999) and synthesis (Hanemaaijer et al. 1997), nitric oxide synthesis (Amin et al., 1996), collagenases activity (Shlopov et al., 1999), and B cell activation (Kuzin et al., 2001). Orally administered, doxycycline is capable to inhibit experimental choroidal neovascularization (Samtani et al., 2009). On the ocular surface, findings demonstrated that doxycycline suppresses expression of stimulated MMP-1, -13, and -10 at the mRNA and protein levels (Li et al. 2003), MMP-9 production (Li et al. 2001), and IL-1 expression and activity (Solomon et al. 2000) by human corneal epithelial cells. In an experimental model of dry.