From the Guidelines
Atropine ophthalmic solution is administered in the nonamblyopic eye, not both eyes, for the treatment of amblyopia in children. The most recent and highest quality study, published in 2023 in the journal Ophthalmology 1, supports the use of atropine 1% solution in the fellow eye as an effective method of treatment for mild to moderate amblyopia in children.
Key Points
- Atropine 1% ophthalmic solution is used to produce cycloplegia of the nonamblyopic eye, which helps to improve vision in the amblyopic eye 1.
- The treatment works best when the nonamblyopic eye is hyperopic, as the cycloplegia optically defocuses the nonamblyopic eye 1.
- Atropine appears to be as effective as occlusion in treating amblyopia, with a benefit that is stable through 15 years of age 1.
- Pharmacological treatment has been prescribed using a variety of dosage schemes, including daily dosing and twice weekly dosing, with modest improvement reported in children with severe amblyopia 1.
Administration and Side Effects
- Atropine 1% solution is typically administered to the nonamblyopic eye, with a prescribed dose of twice weekly for children with moderate amblyopia 1.
- Pharmacological treatment of amblyopia may have ocular and systemic side effects, including transient reduction of VA in the nonamblyopic eye, reverse amblyopia, and systemic effects such as dryness of the mouth and skin, fever, delirium, and tachycardia 1.
- Monitoring the VA of each eye of a child being treated is essential, and fellow eye acuity can be assessed more accurately when atropine is discontinued at least 1 week before testing 1.
From the Research
Administration of Atropine Ophthalmic Solution
- Atropine ophthalmic solution is administered in both eyes, as seen in studies where it was used to induce cycloplegic refraction in children with hypermetropia 2, 3.
- In one study, atropine 1% was administered twice in each eye to induce cycloplegic refraction 2.
- Another study used atropine ointment 1% administered twice a day for 3 days in both eyes to induce cycloplegia 3.
- A study on the effect of low-dose atropine on binocular vision and accommodation in children also administered atropine eye drops in both eyes 4.
Specific Studies
- A 2016 study compared the cycloplegic effect of atropine with cyclopentolate and tropicamide combination in children with hypermetropia, and administered atropine 1% in both eyes 2.
- A 2023 study compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% in children, and administered atropine ointment 1% in both eyes 3.
- A 2023 study on the effect of low-dose atropine on binocular vision and accommodation in children administered atropine eye drops in both eyes, with concentrations of 0.01%, 0.03%, and 0.05% 4.