All About Atropine

Key points

During eye exams, a 1% atropine solution is used to widen the pupil and temporarily stop the eye from focusing, which helps measure prescriptions in some children. This causes light sensitivity and difficulty in reading up close.
Atropine eye drops also have another purpose – they can slow down how quickly myopia worsens in kids, a process called myopia control. The effectiveness of atropine depends on how strong it is – stronger versions slow eye growth more but might have more side effects.
Usually, concentrations between 0.01% and 0.05% are used for long-term myopia control, causing only minor effects on light sensitivity and close-up vision.


In this article

  • Atropine has a long history in medicine dating back to the 1800s. In the field of eye care, it has garnered renewed interest due to its capacity to decelerate the advancement of myopia in children.
  • What is atropine?
  • Why is atropine used in medicine?
  • Why is atropine used in eye care?
  • Why is atropine eye used for myopia control?
  • What are the potential side effects of using atropine for myopia control?
  • How are the ocular side effects of atropine managed?
  • What are the systemic effects of atropine eye drops?
  • Would some kids not be suitable for atropine treatment?
  • Is atropine safe to use?

What is atropine?

Atropine is a pharmaceutical compound derived from the Atropa Belladonna plant. The term "belladonna" originates from Italian, signifying "beautiful woman." This name harks back to a historical practice during the 1300s and 1400s, where women would apply the plant's leaves onto their eyes in the belief that it would enlarge their pupils and enhance their attractiveness.


Why is atropine used in medicine?

Atropine, originally developed in the 1800s, has found application in the medical treatment of various ailments, encompassing heart disease, respiratory disorders, gastrointestinal issues, and certain eye-related problems.

However, one drawback associated with atropine lies in its limited therapeutic selectivity, signifying its impact on numerous bodily functions. This contrasts with the contemporary medical approach that strives for heightened therapeutic selectivity, aiming to precisely target treatments to specific body areas.

Despite this lack of selectivity, atropine continues to be employed for certain medical purposes. Nevertheless, the potential side effects spanning different body systems must always be taken into account. Notably, inappropriate use, such as ingestion instead of appropriate ocular application, can lead to toxicity and potentially serious consequences.

Why is atropine used in eye care?

When formulated as an eye drop, atropine elicits the same effect as the historic practice of Renaissance Italian women rubbing Belladonna plant leaves on their eyes – namely, it induces pupil dilation.

Enlarged pupils offer optometrists an expanded view of the posterior eye, akin to surveying the entire rear wall of a room through a window, as opposed to a keyhole. Atropine widens the pupil (akin to a keyhole) and facilitates comprehensive observation of the posterior eye structures.

Employing a drug in this manner is termed 'diagnostic,' signifying its use for observation rather than treatment. A drawback of atropine as a diagnostic agent for pupil dilation lies in its prolonged duration of action, which extends beyond the requisite observation period. This circumstance prompted the development of more short-lived diagnostic agents. Consequently, atropine is now infrequently employed for pupil dilation.

Atropine eye drops application in various scenarios:

During an eye examination, they are commonly utilized to temporarily enlarge the pupil and immobilize the eye's focusing mechanism. This facilitates accurate testing of a child's spectacle prescription, particularly crucial for those with amblyopia (lazy eye) or strabismus (turned eye). Termed cycloplegic refraction, these drops are typically administered 30-60 minutes prior to the eye exam.

Atropine eye drops are prescribed as a home-based treatment for amblyopia (lazy eye) in children aged 3 to 12. This serves as an alternative to patching the stronger eye.
In instances of severe infection or inflammation causing eye pain, atropine eye drops are employed as a treatment. Such conditions can affect both children and adults.
Children with progressive myopia can be prescribed atropine eye drops to impede myopia progression, a practice also referred to as myopia control.


Why is atropine eye used for myopia control?

Atropine has demonstrated significant efficacy in managing myopia progression. Initial trials involving 1% atropine eye drops to slow myopia progression in children exhibited notable drawbacks, including light sensitivity due to enlarged pupils and blurred near vision.

Recent research over the past decade has focused on investigating lower atropine concentrations with fewer side effects. The concentrations studied for myopia control span from 0.01% to 1%. The optimal balance between minimal side effects and maximum efficacy for myopia control appears to lie within the range of 0.025% to 0.05% based on current research.

For myopia control purposes, atropine drops are administered once nightly. The precise mechanism by which atropine attenuates myopia progression in children remains under investigation. Scientists are actively exploring how atropine eye drops influence the conduction of chemical signals within the retina, the light-sensitive layer at the rear of the eye.

What are the potential side effects of using atropine for myopia control?

As mentioned earlier, atropine's ability to dilate the pupil has been discussed. However, it also affects the eye's internal focusing lens, impairing the eye's capacity to adapt for near vision. This leads to blurry vision when reading or doing close-up tasks. This effect is more pronounced when using atropine concentrations ranging from 0.1% to 1%.

While these effects serve their purpose during eye exams, treating lazy eye in children, or addressing eye inflammation, they are undesirable in myopia control due to their impact on vision.

Fortunately, recent studies have revealed that effective myopia control benefits can be attained using lower atropine concentrations of 0.025% to 0.05%. At these reduced levels, atropine has minimal influence on pupil size and eye focusing, substantially mitigating these undesired side effects.
How are the ocular side effects of atropine managed?

Most research on myopia control has noted a slight increase in pupil size due to atropine treatment. However, this effect is generally small and not significant enough to cause issues. Atropine concentrations of 0.025% and 0.05% have demonstrated a pupil size increase of approximately 1mm, whereas concentrations of 0.1% and higher can lead to an increase of 3mm or more.

A larger pupil allows more light to enter the eye, potentially causing heightened light sensitivity. Shielding children's eyes from ultraviolet (UV) exposure is particularly crucial, as their pupils are wider and the eye's focusing lens is clearer. This makes more light and UV radiation reach the back of the eye in comparison to adults.
In cases where a child undergoing atropine treatment for myopia control seems sensitive to light or glare—exhibiting excessive squinting when outdoors—prescription sunglasses or photochromic spectacle lenses (which darken in bright light) can be recommended.

More light entering the eye can make the sun more harmful to the eyes. So, kids getting atropine treatment need extra protection from sunlight. This means wearing sunglasses or special lenses that get darker in bright light, and wearing a hat with a wide brim when they're outside in the sun.
Another notable side effect to be vigilant about is difficulties in focusing on close-up tasks like reading or screen work. Generally, these effects remain minor in atropine concentrations of up to 0.05%. However, individual variations exist among children.

Should you observe your child holding reading material farther away than usual or experiencing eye rubbing during reading, it is prudent to inform your optometrist or eye doctor for additional guidance. In such cases, eyeglasses featuring added reading power at the lower part of the lenses (known as progressive addition or bifocal lenses) can be prescribed to enhance reading vision.


What are the systemic effects of atropine eye drops?

Atropine eye drops, when applied to the eye, are designed to have minimal impact on the body beyond the eye itself. Safety studies conducted over a span of 2 to 4 years for myopia control in children have shown their favorable profile. To ensure optimal absorption and prevent unnecessary drainage into the nose, a technique known as the DOT (Don't Open Eyes) method can be employed. This involves closing the eye after applying the drop and gently pressing the inside corner of the eye for a minute or more.

If atropine eye drops are swallowed by mistake, they can affect the whole body. This might lead to a faster heartbeat, less sweating and saliva, higher body temperature, and confusion. Because these effects can be dangerous, it's really important for parents to watch over how the drops are used and stored.
Making sure atropine eye drops are used safely is very crucial. If a young child accidentally swallows a whole bottle of these drops, it can be very harmful. Always keep the eye drops in a safe place where kids can't reach them.

If you think your child might have swallowed atropine eye drops, call a doctor right away.

Would some kids not be suitable for atropine treatment?

While atropine eye drops are generally safe, some children and teenagers may not be suitable for them due to other health conditions or medications they're taking.

Kids with certain heart conditions might not be able to use atropine because it can affect their heart rate.

Also, if a child or teenager is taking certain medications for asthma, depression, anxiety, or allergies, using atropine could cause more side effects. It's important to be careful when considering atropine treatment for kids on these medications.


Is atropine safe to use?

Atropine eye drops for myopia control are usually very weak, so they don't have significant effects on the body when used in the eye. The eye can only hold a small amount of drops before it overflows and doesn't absorb more.

Many studies have shown that atropine is safe and well-tolerated by kids and teenagers.

If you have any questions, talk to your eye doctor. Follow the treatment plan they give you for your child.


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