Can atropine eye drops be used for glaucoma?

Atropine Eye Drops Are Not Recommended for Glaucoma Treatment

Atropine eye drops should not be used for glaucoma treatment as they can increase intraocular pressure (IOP) and potentially worsen glaucomatous damage. 1

Mechanism of Action and Contraindication

• Atropine is an anticholinergic agent that causes pupillary dilation (mydriasis) and cycloplegia, which can lead to angle closure and increased IOP in susceptible individuals 1
• Research in animals has demonstrated that topical atropine application can significantly increase IOP, making it unsuitable for glaucoma management 1
• Atropine's mechanism directly opposes the goals of glaucoma therapy, which aims to reduce IOP to prevent further optic nerve damage 2

Recommended First-Line Treatments for Glaucoma

• Prostaglandin analogs are the recommended first-line medical therapy for primary open-angle glaucoma due to their superior efficacy (20-35% IOP reduction), once-daily dosing, and favorable side effect profile 3
• When selecting glaucoma medication, the goal is to maintain IOP in a range where visual field loss is unlikely to significantly affect quality of life 2
• A reasonable target IOP is typically 20% lower than baseline measurements, based on the Ocular Hypertension Treatment Study (OHTS) 2

Alternative Medication Classes for Glaucoma

• Beta-adrenergic antagonists (e.g., timolol) can reduce IOP by 15-25% but may cause systemic side effects like bradycardia and bronchospasm 3, 4
• Alpha-2 adrenergic agonists (e.g., brimonidine) can reduce IOP by 15-25% but may cause ocular allergic reactions 3
• Topical and oral carbonic anhydrase inhibitors decrease aqueous production and can reduce IOP by 15-30% 2
• Rho kinase inhibitors (e.g., netarsudil) increase trabecular outflow and can reduce IOP by 10-20% 2, 5

Treatment Algorithm for Glaucoma

1. Start with a prostaglandin analog as first-line therapy unless contraindicated 3
2. If target IOP is not achieved with a single medication, consider:
   • Adding a second medication from a different class 3
   • Using fixed-combination therapy to improve adherence 2
   • Evaluating for laser trabeculoplasty as an alternative or adjunctive therapy 3, 5
3. Monitor IOP, optic nerve structure, and visual fields regularly to assess treatment efficacy 3

Potential Pitfalls in Glaucoma Management

• Poor medication adherence is common and can be improved with once-daily dosing regimens 2, 6
• Ignoring systemic comorbidities when selecting medications can lead to adverse effects 3, 4
• Inadequate follow-up can result in disease progression despite treatment 3
• Using medications that can increase IOP (like atropine) can worsen glaucomatous damage 1

Appropriate Uses for Atropine Eye Drops

• Atropine is indicated for myopia control in children, not for glaucoma treatment 2
• Low-dose atropine (0.01%-0.05%) has been shown to slow myopia progression with minimal side effects 2
• Atropine may be used for other ophthalmic conditions like uveitis or prior to certain eye examinations, but is contraindicated in glaucoma 2