Atropine eye drops for myopia control in children

• Atropine eye drops have multiple uses in childhood eye care, from increasing eye examination accuracy to treatment for lazy eye, to managing eye inflammation.
• In primary-school aged children, atropine 1% can be used for the reasons described above, and atropine 0.01%, 0.025% or 0.05% can be used to slow myopia progression.
• Atropine eye drops 0.01%, 0.025% or 0.05% for myopia control have evidence for use in children aged 4 to 12 years at the start of treatment, and for up to three years.

Myopia, also known as short-sightedness or near-sightedness, causes vision to become blurred in the long distance, and the need for glasses or contact lenses to see clearly.

In most cases, myopia starts in childhood, and then progressively increases up until early adulthood when it stabilizes.1  Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, causing the World Health Organization to classify myopia as a global health concern.2 

'Myopia control' has become the increasingly adopted term to describe the use of treatments aimed to slow progression of myopia. These treatments can include spectacles, contact lenses or atropine eye drops. Myopia control is particularly important in children, because this is the stage in life when myopia is most likely to progress or worsen quickly. Taking action to control progression of myopia in children during this fast progression stage in their life will therefore likely achieve the most gains.3 

Atropine is used in general medicine, and also as an eye medicine or eye drop. As an eye drop, atropine 1% is used to dilate (enlarge) the pupil and stop the eye’s focusing mechanism, which can be used for testing the vision of young children, treating amblyopia (lazy eye) and also for managing some eye diseases.4 

The first studies using atropine eye drops to slow myopia progression in children used 1% atropine, but these had significant side effects – enlarged pupils made a child sensitive to light, and blurred their close-up vision.5 

Newer studies have investigated lower concentrations of 0.01% up to 0.05%, which have minimal side effects. Atropine eye drops for myopia control are used once per day, at night time.6 

Atropine 1% concentration was first shown to work effectively to slow myopia progression in children aged 6-12 years, who were followed for two years.⁵ This concentration (strength or dose) has significant side effects of increased light sensitivity and blurred near (close up) vision. Another study on 0.1% and 0.5% found these concentrations also had significant side effects.7 

Atropine 0.01% to 0.05% has been shown to have minimal side effects in children who were 4 to 12 years of age at the start of treatment.6  This three year study showed that these low concentrations were safe, well tolerated and had minimal side effects.

A well known study from Singapore published in 2016 compared 0.01%, 0.1% and 0.5% atropine for childhood myopia control, and found that 0.01% worked similarly to the others with far less side effects.8  This led to increasing popularity of 0.01% atropine for myopia control.

Further analysis of that data found some flaws in assuming 0.01% works best,9  and newer studies since have found that 0.01% atropine, by itself, is quite a weak treatment for myopia control.^6,10

Better outcomes have been found with 0.02%, 0.025% and 0.05% atropine concentrations. These have been researched in children from age 4 and up to age 14 at the start of treatment, for 2-3 years in total.6,10 

Atropine 0.02% and 0.025% have been shown to slow myopia progression by about one-third, and atropine 0.05% by about one-half, compared to children on placebo treatment.6,10 

Compared to other treatments for myopia control, atropine appears to work similarly to the best spectacle, contact lens and ortho-k options.11,12  The ideal myopia control treatment for your child will depend on a number of factors, including their eye measurements, capabilities, activities and more.

Atropine 0.01% has been shown to be effective when combined with ortho-k contact lens wear, boosting the short-term myopia control effect in children aged 6-11 years.12  Read more in our article ortho-k for myopia control.

There are no myopia control treatments that can promise to stop myopia progression, but they can help to slow it down.3  Atropine treatment will be working, firstly, if your child can see clearly with their spectacles or contact lenses and are tolerating the treatment well with minimal side effects.3 

Myopia progression can be measured either by measuring change to refraction prescription or change in the axial length of the eye, and compared to research data to determine success of a myopia control treatment.

Atropine eye drops have been shown safe to use in children when used as prescribed.13  While atropine has potential for causing toxic effects if taken by mouth, it is greatly diluted when formulated into eye drops. Medication safety is very important - if a young child accidentally swallows a bottle of atropine eye drops this can have very serious side effects.14 

The low concentrations of atropine used in myopia management have far less side effects for long term use, and have proven to be safe and effective for slowing myopia progression in children from age 4 to 14 at the start of treatment, and for up to two to three years.6,10  Amongst these lower concentrations, atropine 0.05% currently appears to be the most effective, with minimal side effects.6 

As for any medication, atropine should be stored securely from children. If you do suspect your child has swallowed atropine eye drops you should immediately seek advice from the prescribing practitioner or a medical doctor.