Antimuscarinic — Cycloplegic / Myopia Control Pregnancy: Use with caution in pregnancy — systemic atropine crosses placenta; topical use low risk

Atropine Eye Drops 1% / 0.01%

Brand names: Minims Atropine, Atropine Sulfate Eye Drops

Adult dose

Dose: 1 drop of 1% once or twice daily (uveitis, amblyopia penalisation); cycloplegia for refraction: 1 drop BD for 3 days before appointment

Route: Topical (ophthalmic)

Frequency: Once to twice daily (therapeutic); 3-day pre-treatment for cycloplegic refraction

Max: 1 drop per dose of 1% solution

Longest-acting cycloplegic/mydriatic — paralysis of accommodation lasts 7–14 days. Systemic absorption can cause significant antimuscarinic toxicity especially in children. Compress nasolacrimal punctum after instillation. 0.01% solution is used for myopia control in children (different indication).

Paediatric dose

Route: Topical

Frequency: Once or twice daily

Max: 1% for cycloplegia in older children; 0.5% in children <3 years

MHRA: systemic atropine toxicity in children — tachycardia, fever, flushing, delirium — from nasolacrimal absorption; ALWAYS use nasolacrimal compression technique; 0.01% atropine for myopia control in children: nightly once daily

Dose adjustments

Renal

No specific adjustment for topical use

Hepatic

No adjustment for topical use

Clinical pearls

Longest-acting cycloplegic: cycloplegia lasts 7–14 days after single drop of 1% atropine — useful for accurate cycloplegic refraction in children with strong accommodation (where cyclopentolate may be insufficient); photophobia and near vision blur persist accordingly
Myopia control: 0.01% atropine once nightly significantly reduces myopia progression in children (ATOM1/ATOM2 Singapore trials) — low-dose atropine is now a recognised intervention for paediatric myopia control in some regions; mechanism involves retinal dopamine signalling rather than cycloplegia
Antimuscarinic toxicity in children: nasolacrimal drainage delivers absorbed atropine systemically — systemic dose from 1 drop of 1% atropine is clinically significant in small children; nasolacrimal punctum occlusion for 1–2 minutes is MANDATORY; symptoms: flushing, fever, tachycardia, restlessness (mad as a hatter, red as a beet, dry as a bone, hot as Hades)
Uveitis management: atropine (or cyclopentolate) is used as cycloplegic in anterior uveitis — relieves ciliary spasm pain and prevents posterior synechiae formation
Physostigmine is the specific antidote for systemic atropine toxicity — available in emergency settings

Contraindications

Angle-closure glaucoma (narrow angles)
Hypersensitivity to atropine
Infants with known susceptibility to atropine effects

Side effects

Photophobia (prolonged mydriasis — up to 14 days) — warn patient
Blurred near vision (cycloplegia)
Systemic antimuscarinic toxicity — dry mouth, flushing, tachycardia, urinary retention, hyperthermia, delirium (especially in children and elderly)
Precipitation of acute angle-closure glaucoma

Interactions

Other antimuscarinics — additive toxicity via systemic absorption
Physostigmine — antagonises atropine; antidote for atropine toxicity

Monitoring

Systemic symptoms in children — heart rate and temperature after instillation
Accommodation recovery (patient should not drive until full accommodation returns — up to 2 weeks with 1%)
IOP in patients with suspected narrow angles

Reference: BNFc; BNF 90; ATOM1/ATOM2 Trials (Singapore Myopia Control); RCOphth Uveitis Guidelines; MHRA Atropine Paediatric Safety; SPC Atropine Eye Drops. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways