What are the doses of atropine (antimuscarinic) eye drops?

From the Guidelines

Atropine drops should be dosed at 1% concentration for children with amblyopia, with a recommended administration frequency of twice weekly. This dosing regimen has been shown to be effective in treating mild to moderate amblyopia in children 3 to 15 years of age, with some success in cases worse than 20/80 1. The benefits of pharmacologic treatment with atropine appear to be stable through 15 years of age, and atropine has been found to be as effective as occlusion in treating amblyopia 1. When administering atropine drops, it is essential to monitor the visual acuity of each eye, as atropine can cause transient reduction of VA in the nonamblyopic eye, especially when used in combination with reduced hyperopic correction 1. Additionally, patients should be advised of potential side effects, including photosensitivity, conjunctival irritation, and systemic anticholinergic effects, and should wear sunglasses outdoors during treatment due to light sensitivity. In terms of myopia control, lower concentrations of atropine, such as 0.01%, have been found to be effective in slowing myopia progression with minimal side effects 1. However, for the treatment of amblyopia, the 1% concentration is recommended, and the twice weekly dosing regimen has been shown to be effective in achieving modest improvement in visual acuity 1. Key points to consider when prescribing atropine drops for amblyopia include:

• Dosing regimen: 1% concentration, twice weekly
• Monitoring: regular visual acuity checks to assess treatment efficacy and potential side effects
• Patient education: advise patients of potential side effects and the importance of wearing sunglasses outdoors during treatment
• Considerations: atropine may not be suitable for children under 3 years of age, and systemic absorption can be reduced by applying gentle pressure to the inner corner of the eye after instillation 1.

From the FDA Drug Label

1. 4 Pediatric Use Due to the potential for systemic absorption of atropine sulfate ophthalmic solution the use of Atropine Sulfate Ophthalmic Solution, 1% in children under the age of 3 months is not recommended and the use in children under 3 years of age should be limited to no more than one drop per eye per day

The recommended dose of atropine drops is:

• No more than one drop per eye per day in children under 3 years of age 2
• Not recommended in children under 3 months of age 2
• No specific dose is mentioned for adults or children over 3 years of age, but it is stated that safety and efficacy in children above the age of 3 months has been established in adequate and well-controlled trials 2

From the Research

Atropine Drops Doses

• The dose of atropine eye drops used for myopia progression reduction can vary, with studies investigating the efficacy of different concentrations, such as 0.01% and 0.1% 3.
• A study found that 0.01% low-dose atropine eye drops were a safe and moderately efficacious intervention in Danish children for reducing myopia progression 3.
• Another study discussed the use of atropine eye drops in myopia control, highlighting the potential benefits and limitations of this treatment, including the risk of side effects 4.
• The preparation of low-dose atropine eye drops using atropine sulfate injection diluted in normal saline and lubricants has also been explored, with results showing that the prepared eye drops were sterile and stable 5.

Administration and Side Effects

• The administration of atropine eye drops can have side effects, including increased intraocular pressure, which was found to increase over two years of treatment but remained within normal limits 3.
• Other potential side effects of mydriatic and cycloplegic drugs, including atropine, include ocular complications such as pigmentation of the conjunctiva and cornea, and systemic complications such as tachycardia and hypertension 6.
• A study on the repeated use of tropicamide and cyclopentolate found that pupils did not dilate as well after the second dose, suggesting that the effectiveness of these drugs may decrease with repeated use 7.