Atropine Dosage for Traumatic Iritis
For traumatic iritis, atropine 1% ophthalmic solution is the recommended dosage, typically administered 2-3 times daily until inflammation resolves.
Mechanism and Rationale
Atropine works as a cycloplegic agent in traumatic iritis by:
- Paralyzing the ciliary muscle to reduce pain from ciliary spasm
- Dilating the pupil to prevent posterior synechiae (adhesions between iris and lens)
- Reducing inflammation by stabilizing the blood-aqueous barrier
Dosing Protocol
Initial Treatment
- Concentration: 1% atropine ophthalmic solution 1
- Frequency: 2-3 times daily (typically every 8-12 hours)
- Duration: Continue until inflammation resolves, usually 5-7 days
Considerations for Specific Populations
- Children: May require closer monitoring for systemic absorption
- Elderly: May be more sensitive to anticholinergic side effects
Administration Technique
- Wash hands thoroughly before administration
- Pull down lower eyelid to create a pocket
- Instill one drop into the affected eye
- Apply gentle pressure to the inner corner of the eye for 1-2 minutes to reduce systemic absorption
- Wait at least 5 minutes before applying any other eye medications
Monitoring and Follow-up
- Regular ophthalmologic evaluation is essential to assess response to treatment
- Monitor intraocular pressure, as prolonged use may increase risk of elevated pressure
- Assess for resolution of anterior chamber cells and flare
Side Effects and Precautions
Common Side Effects
- Blurred vision (especially near vision)
- Photophobia
- Dry mouth
- Flushing
Serious Side Effects (Rare)
- Tachycardia
- Confusion
- Hallucinations (particularly in children)
- Fever
Precautions
- Use with caution in patients with narrow-angle glaucoma
- Avoid in patients with known hypersensitivity to anticholinergic agents
- Apply digital pressure over lacrimal sac during and after administration to reduce systemic absorption 1
Treatment Pearls
- Traumatic iritis typically affects young males and is often sports or work-related 2
- Prompt treatment by an ophthalmologist is strongly recommended to decrease severity, duration, and complications 1
- For patients with recurrent iritis, prescription of topical glucocorticoids for at-home use may be beneficial in addition to atropine 1
- Patients should be advised to wear dark glasses if photophobia is severe
- Avoid using atropine in doses <0.5 mg as this may paradoxically cause bradycardia 1
Common Pitfalls to Avoid
- Failure to refer to an ophthalmologist for proper diagnosis and management
- Inadequate treatment duration leading to recurrence of inflammation
- Not monitoring for potential side effects, especially in children
- Missing underlying causes of traumatic iritis that may require additional treatment
Remember that traumatic iritis requires prompt treatment to prevent complications such as synechiae formation, secondary glaucoma, and potential vision loss.