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Atropine (ophthalmic) Atropine eye drops are the topical form of the same antimuscarinic alkaloid, used on the eye rather than taken systemically. At 1% they paralyse accommodation and dilate the pupil, which is what makes them useful for eye examinations, for resting an inflamed eye in uveitis, and for penalisation therapy in childhood amblyopia, where the stronger eye is blurred so the weaker one is forced to work. A separate and much lower concentration, typically 0.01% to 0.05%, is used to slow the progression of short-sightedness in children, and that use is supported by its own body of randomised trials. This entry covers the eye drops; systemic atropine, including its deliriant use at high doses, is a different subject with a different risk profile.
- Standard for cycloplegia and pupil dilation
- Rests an inflamed eye in uveitis
- Used for amblyopia penalisation in children
- Low-dose form slows childhood myopia
- Cheap and long established
- ATOM1 established that atropine 1% controls myopia progression but at an unacceptable cost in cycloplegia and mydriasis; ATOM2 then showed 0.01% retains most of the benefit with negligible effect on accommodation and pupil size and zero cases of allergic conjunctivitis versus 16 at higher concentrations (PMID 16996612, PMID 21963266).
- The five-year ATOM2 report contains the counterintuitive finding that matters most: higher concentrations produce a larger rebound on washout, so 0.01% ends up MOST effective over five years (-1.38 D) despite being least effective at two years, versus -1.83 D at 0.1% and -1.98 D at 0.5% [3].
- LAMP found a clean concentration-response over one year: mean spherical equivalent change -0.27 D at 0.05%, -0.46 D at 0.025%, -0.59 D at 0.01% and -0.81 D on placebo, with 0.05% the most effective of the three [4].
- CHAMP-UK, a 289-child UK multicentre placebo-controlled trial reported in the BMJ, confirmed 0.01% atropine works outside East Asian populations: mean difference 0.33 D (95% CI 0.17-0.49) and 0.14 mm less axial elongation over two years, with no difference in adverse events [7].
- The effect is not a cycloplegic effect: 0.01% produces only about 0.5 mm of pupil dilation and essentially no loss of accommodation, yet still slows axial elongation, which points to a scleral or choroidal mechanism rather than an accommodative one (PMID 30514630, PMID 21963266).
- The Cochrane living network meta-analysis places atropine among the best-supported myopia-control interventions available, alongside orthokeratology and peripheral-defocus spectacle lenses [8].
Mechanism
receptor fingerprint
receptor M1 (CHRM1)Competitive, non-selective antagonist
receptor M3 (CHRM3)Competitive antagonist; the receptor on iris sphincter and ciliary muscle
receptor M4 (CHRM4)Competitive antagonist
receptor M5 (CHRM5)Competitive antagonist
Scleral and choroidal signalling controlling axial elongationSlows axial elongation of the globe by a mechanism that is NOT explained by cycloplegia or mydriasis
Evidencehow good the literature is
Strong clinical evidence for its licensed eye uses; separate and growing evidence for low-dose myopia control
Safetyrisks and cautions, not medical advice
These are prescription eye drops and the 1% strength is not a mild preparation. Vision blurs for near work and the eye becomes light sensitive, both of which can last a week or more after a single drop, so driving and screen work are affected far longer than people expect. The drug does not stay in the eye: enough is absorbed through the nasolacrimal duct to produce systemic anticholinergic effects, and children are markedly more susceptible, with flushing, fever, a dry mouth, a fast heartbeat and confusion all reported after ordinary ophthalmic dosing. Pressing on the inner corner of the eye after instilling reduces that absorption. It must not be used in anyone with narrow-angle glaucoma, where dilating the pupil can precipitate an acute attack that threatens sight.
Subjective profileweighing the evidence above
A legitimate and cheap prescription eye drop with real uses, and not the same proposition as the systemic drug that shares its name. The 1% strength is a clinical tool rather than something to experiment with: a week of unusable near vision from one drop is the normal outcome, not a side effect. The low-dose myopia-control use is the genuinely interesting one and it is a different concentration entirely, prescribed and monitored, not the bottle sold as 1%.
Resources
This entry is here for reference.
Research
- 2006first citedAtropine for the treatment of childhood myopia.
- 2026most recentLow concentration atropine eye drops and progression of myopia in children: multicentre placebo…
- 1.Atropine for the treatment of childhood myopia.
- 2.Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2).
- 3.Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops.
- 4.Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control.
- 5.Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report.
- 6.Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Pediatric Myopia Progression Over 3 Years: A Randomized Clinical Trial.
- 7.Low concentration atropine eye drops and progression of myopia in children: multicentre placebo controlled, double masked, randomised trial in the UK (CHAMP-UK).
- 8.Interventions for myopia control in children: a living systematic review and network meta-analysis.
8 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
Notes and cautions
- At myopia-control concentrations (0.01% to 0.05%) atropine is remarkably well tolerated: the main effects are mild photophobia from pupil dilation and, at 0.05% and above, some loss of near focus that may need reading correction.
- Allergic conjunctivitis and contact dermatitis of the lids were common at 0.1% and 0.5% but absent at 0.01% in ATOM2 [2].
- The important practical points are that treatment must be sustained, because stopping produces rebound progression that is worse the higher the concentration used [3], and that compounded low-concentration drops vary in concentration, pH and preservative between pharmacies, so a licensed preparation is preferable.
- This is entirely distinct from systemic atropine, where anticholinergic toxicity, tachycardia, delirium and hyperthermia are real; ophthalmic drops in a small child should still be handled to avoid swallowing, and punctal occlusion reduces systemic absorption.