Atropine Eye Drops for Myopia Control: How They Work, Benefits, Risks and What Parents Should Know

Author: Dr Val Phua
Estimated reading time: 13–15 minutes

Can Atropine Eye Drops Slow Childhood Myopia?

Yes.

Atropine eye drops can slow the progression of childhood myopia and reduce excessive elongation of the eyeball.

Myopia, or short-sightedness, usually increases during childhood because the eye grows too long from front to back. This is known as axial elongation.

Atropine does not remove the child’s existing myopia or eliminate the need for glasses. Its purpose is to reduce the rate at which the prescription and axial length increase.

Low-concentration atropine is now widely used as one of several evidence-based myopia-control treatments. Other options include specialised spectacle lenses, soft myopia-control contact lenses and orthokeratology.

Why Is Slowing Myopia Important?

Myopia is more than an inconvenience corrected by spectacles.

As a myopic eye becomes longer, the retina, choroid and sclera become stretched over a larger surface.

Higher levels of myopia are associated with greater lifetime risks of:

• Retinal tears and retinal detachment
• Myopic macular degeneration
• Glaucoma
• Cataract
• Abnormal blood vessels beneath the retina
• Permanent visual impairment

Myopia control aims to reduce the child’s final level of myopia and therefore reduce—although not eliminate—these long-term risks.

What Is Atropine?

Atropine is an antimuscarinic medication that has been used in ophthalmology for many years.

At higher concentrations, atropine:

• Enlarges the pupil
• Temporarily relaxes the eye’s focusing muscle
• Blurs near vision
• Reduces pain and inflammation in selected eye conditions
• Allows more accurate measurement of a child’s spectacle prescription

For myopia control, atropine is usually prescribed at a much lower concentration than the traditional 1% preparation used for dilation or inflammation.

Common myopia-control concentrations include:

• 0.01%
• 0.025%
• 0.05%

Other concentrations may be used according to the child’s response, side effects and local clinical practice. Singapore’s HealthHub recognises slowing myopia in children and teenagers as one of the uses of atropine eye drops.

How Does Atropine Slow Myopia?

The precise mechanism is not fully understood.

Atropine was once thought to work mainly by relaxing accommodation—the focusing effort used for near work. Research now indicates that its myopia-control effect is not explained simply by reducing accommodation.

Atropine appears to act on biochemical signalling pathways involving structures such as the:

• Retina
• Choroid
• Sclera
• Retinal pigment epithelium

These signals influence how quickly the eyeball elongates.

Biometric analysis from the LAMP trial found that atropine’s effect was primarily associated with reduced axial elongation rather than major changes in corneal or natural-lens focusing power.

Does Atropine Shorten the Eyeball?

No.

The usual goal is to slow further elongation, not to reverse structural growth that has already occurred.

Small apparent reductions in axial length may occasionally be recorded because of:

• Measurement variability
• Changes in the choroid
• Differences between instruments
• Short-term biological effects

Parents should not expect atropine to permanently shorten the eye or erase the existing prescription.

Does Atropine Correct Blurred Distance Vision?

No.

Atropine is not a replacement for glasses or contact lenses.

A child using atropine still requires appropriate optical correction, which may include:

• Ordinary single-vision glasses
• Specialised myopia-control spectacles
• Daytime soft contact lenses
• Orthokeratology

Atropine addresses eye growth. Glasses or contact lenses provide clear vision.

Who May Benefit from Atropine?

Atropine may be considered when:

• Myopia has begun during childhood
• The prescription is increasing
• Axial length is increasing faster than expected
• Myopia started at a young age
• One or both parents have myopia
• The child is at risk of developing high myopia
• Spectacle treatment alone is not providing sufficient control
• Contact lenses are unsuitable
• The child has allergy, dry eye or hygiene concerns that make contact lenses difficult
• Myopia continues progressing despite another form of treatment

The decision should consider age, prescription, axial length, previous progression and the child’s ability to tolerate the medication.

Does Every Myopic Child Need Atropine?

No.

Some children may be better suited to:

• Myopia-control spectacles
• Dual-focus soft contact lenses
• Orthokeratology
• Lifestyle measures with careful observation
• A combination of optical treatment and atropine

A child whose myopia is stable may not need immediate pharmacological treatment.

Atropine should be prescribed as part of an individual myopia-management plan rather than automatically given to every child who wears glasses.

Why Does the Atropine Concentration Matter?

Atropine demonstrates a dose-dependent effect.

In general:

• Higher concentrations produce stronger myopia control.
• Higher concentrations also produce more pupil dilation and near-focusing effects.
• Lower concentrations are usually easier to tolerate.
• Very low concentrations may provide insufficient control for some children.

The aim is to find a concentration that provides meaningful slowing of axial growth with acceptable side effects.

How Effective Is 0.05% Atropine?

Among 0.01%, 0.025% and 0.05% atropine, the LAMP trial found that 0.05% provided the greatest reduction in both refractive progression and axial elongation.

During the first year, average progression was approximately:

• –0.27 D with 0.05% atropine
• –0.46 D with 0.025%
• –0.59 D with 0.01%
• –0.81 D with placebo

Average axial elongation was approximately:

• 0.20 mm with 0.05%
• 0.29 mm with 0.025%
• 0.36 mm with 0.01%
• 0.41 mm with placebo

All three concentrations were generally well tolerated, but pupil enlargement and reduction in accommodation increased with concentration.

What Happened Over Two Years?

The concentration-dependent difference continued during the two-year LAMP study.

Average refractive progression over two years was approximately:

• –0.55 D with 0.05%
• –0.85 D with 0.025%
• –1.12 D with 0.01%

Average axial elongation was approximately:

• 0.39 mm with 0.05%
• 0.50 mm with 0.025%
• 0.59 mm with 0.01%

These findings supported 0.05% as the most effective of the three low concentrations studied in that population.

Does 0.01% Atropine Work?

The evidence for 0.01% atropine is mixed.

The International Myopia Institute identified 21 randomised trials of 0.01% atropine. The median reduction in axial elongation was approximately:

• 0.08 mm after one year
• 0.12 mm after two years

This indicates a modest average effect, with substantial variation between trials.

A US Paediatric Eye Disease Investigator Group trial found that nightly 0.01% atropine did not significantly reduce refractive progression or axial elongation compared with placebo.

In contrast, the CHAMP trial found evidence of benefit with a specific 0.01% formulation, and its four-year report described negligible rebound after three years of treatment.

These differing results suggest that effectiveness may vary according to:

• Formulation
• Population
• Baseline age
• Ethnicity
• Preservatives
• Study design
• Natural progression rate
• Adherence

Parents should not assume that every 0.01% preparation will produce the same effect.

Is 0.025% a Reasonable Middle Option?

Yes.

Atropine 0.025% may provide greater efficacy than 0.01% with fewer visual side effects than 0.05% in some children.

It may be considered when:

• The child has moderate progression
• 0.01% appears insufficient
• The child has difficulty tolerating 0.05%
• Light sensitivity or near blur is a concern
• A gradual dose-escalation strategy is being used

The choice should be based on actual progression and tolerance rather than assuming that every child should start at the same concentration.

Are Higher Atropine Concentrations Ever Used?

Yes.

Historically, concentrations such as:

• 0.1%
• 0.5%
• 1%

have been used for myopia control.

Higher concentrations can provide stronger control but are more likely to cause:

• Significant pupil enlargement
• Light sensitivity
• Loss of near focusing
• Need for reading additions
• Allergy
• Greater rebound after stopping

For this reason, modern practice commonly starts with a lower concentration, although higher doses may still be considered in selected rapidly progressing cases.

Which Concentration Should My Child Start With?

There is no universal starting concentration.

The decision may depend on:

• The child’s age
• Rate of refractive progression
• Rate of axial elongation
• Current level of myopia
• Family history
• Risk of high myopia
• Pupil size
• Near-work demands
• Outdoor exposure
• Sensitivity to light
• Whether another treatment is being used

Younger children may require stronger treatment to achieve a response comparable with that of older children. An age analysis from the LAMP trial found that younger age was associated with a poorer response across all three low concentrations, and younger children often required 0.05% to achieve control comparable with lower concentrations in older children.

Is It Better to Start Low and Increase the Dose?

This is one reasonable strategy.

A clinician may:

1. Begin with a selected low concentration.
2. Measure refractive and axial progression.
3. Assess light sensitivity and near vision.
4. Increase the concentration if control is inadequate.
5. Add or change optical treatment when necessary.

Another approach is to begin with 0.05% in a young or high-risk child, then reduce the dose later if side effects are troublesome or progression stabilises.

Neither strategy is best for every child.

How Are Atropine Drops Usually Given?

Atropine for myopia control is commonly used:

• Once daily
• Usually in the evening or before bed
• In both myopic eyes
• Alongside glasses or contact-lens correction

The exact dose and timing should follow the prescription label.

One drop is sufficient. Additional drops do not improve effectiveness and may increase systemic absorption.

How Should Parents Instil the Drops?

A practical method is:

1. Wash and dry your hands.
2. Check the bottle label and concentration.
3. Ask the child to sit back or lie down.
4. Gently pull the lower eyelid down to form a pocket.
5. Instil one drop without touching the eye, eyelashes or skin with the bottle tip.
6. Ask the child to close the eye gently.
7. Press the inner corner of the eyelids beside the nose for one to two minutes.
8. Wipe away excess medication with a clean tissue.
9. Replace the cap immediately.

Pressing the inner corner reduces drainage of the medication into the nose and may reduce systemic absorption.

Why Should the Bottle Tip Not Touch the Eye?

Touching the eye, lashes or fingers can contaminate the bottle.

A contaminated bottle may cause:

• Conjunctivitis
• Corneal infection
• Recurrent irritation
• Contamination of subsequent doses

The dropper tip should remain clean and should not be wiped using a household tissue unless the product instructions specifically advise this.

What If a Dose Is Missed?

Use the drop when remembered unless it is close to the next scheduled dose.

In that case:

• Skip the missed dose.
• Use the next dose at the normal time.
• Do not apply two doses together.

An occasional missed dose is unlikely to undo treatment, but repeated missed doses may reduce effectiveness.

What Are the Common Side Effects?

The most common side effects are related to atropine’s effects on the pupil and focusing system.

These include:

• Mild stinging
• Temporary redness
• Larger pupils
• Glare
• Increased light sensitivity
• Mild near blur
• Difficulty reading very small print
• Headache
• Awareness of bright headlights
• Mild allergy or eyelid irritation

Side effects are generally more common with increasing concentration. Low-dose atropine is usually better tolerated than full-strength atropine.

Why Does Atropine Cause Light Sensitivity?

The pupil normally becomes smaller in bright light.

Atropine partially blocks this response, allowing more light to enter the eye.

Children may notice:

• Discomfort in bright sunlight
• Glare from reflective surfaces
• Difficulty adapting when moving outdoors
• Larger-looking pupils

Helpful measures include:

• UV-protective sunglasses
• Photochromic spectacle lenses
• A cap or wide-brimmed hat
• Avoiding direct staring at intense light

Will Sunglasses Reduce the Benefit of Outdoor Time?

No.

Children should still spend time outdoors.

Normal sunglasses and hats do not eliminate the protective association between outdoor exposure and myopia onset. Sun protection remains appropriate, particularly in Singapore’s bright climate.

Why Can Atropine Blur Near Vision?

Atropine reduces the ability of the ciliary muscle to change the natural lens’s focus for near tasks.

The effect depends on:

• Concentration
• Child’s age
• Baseline focusing ability
• Reading distance
• Amount of near work

Most children using low concentrations can continue ordinary schoolwork without difficulty.

Children with significant near blur may benefit from:

• A lower atropine concentration
• A reading addition
• Progressive or bifocal spectacle lenses
• Larger print
• Improved working distance
• Better lighting

Singapore HealthHub notes that progressive or reading additions may be recommended for children experiencing near blur.

Can Atropine Affect School Performance?

Most children tolerate low-concentration atropine without meaningful disruption to school activities.

Problems may occur when a child develops:

• Significant near blur
• Headache
• Glare
• Difficulty shifting focus between the board and books
• Reluctance to use the drops

These concerns should be addressed rather than assuming the child must simply tolerate them.

The concentration or optical correction can often be adjusted.

Can Atropine Cause Allergy?

Yes.

Possible allergic features include:

• Itchy or red eyelids
• Eyelid swelling
• Persistent eye redness
• Watering
• Rash around the eye
• Generalised skin rash

Allergy may be caused by:

• Atropine itself
• A preservative
• Another ingredient in the formulation

The drops should be stopped and medical advice obtained if significant allergy is suspected.

Facial swelling, tongue swelling or difficulty breathing requires immediate medical attention.

Are Serious Side Effects Possible?

Serious systemic side effects are very rare when low-concentration drops are used correctly.

Possible signs of excessive atropine exposure include:

• Fast or irregular heartbeat
• Facial flushing
• Dry mouth
• Restlessness
• Irritability
• Confusion
• Dizziness
• High fever
• Difficulty passing urine

These effects are more likely after:

• Accidental swallowing
• Excessive dosing
• Use of a much stronger concentration
• Improper storage
• Failure to use punctal occlusion
• Increased individual sensitivity

Seek urgent medical advice if these symptoms develop.

What Should I Do If My Child Swallows Atropine?

Atropine bottles should be stored securely away from children.

If a child swallows the medication:

• Do not wait for symptoms.
• Contact emergency medical services or a poison-information service.
• Bring the bottle and packaging.
• State the concentration and estimated amount swallowed.
• Do not induce vomiting unless directed.

Accidental ingestion can produce more significant systemic effects than normal ophthalmic use.

Who Requires Additional Precaution?

Tell the prescribing clinician if the child:

• Has an allergy to atropine or any ingredient
• Has narrow or closed anterior-chamber angles
• Uses other dilating or anticholinergic medication
• Has a significant cardiac-rhythm disorder
• Has difficulty passing urine
• Has a neurological or developmental condition affecting medication tolerance
• Is pregnant or breastfeeding
• Has previously experienced severe systemic side effects
• Is using another eye preparation

Narrow-angle glaucoma is uncommon in children but should be considered when the ocular anatomy or medical history is unusual.

Can Atropine Raise Eye Pressure?

Atropine is not normally associated with chronic pressure elevation in healthy children.

It can theoretically precipitate angle closure in an anatomically narrow eye because it enlarges the pupil.

Children receiving prolonged treatment should still undergo appropriate ocular examination, particularly when they have:

• Unusual anterior-segment anatomy
• A strong glaucoma history
• Previous eye surgery
• Eye pain with headache or nausea
• Halos and sudden visual blur

How Is Treatment Monitored?

Monitoring should include more than simply asking whether the child is using the drops.

A typical follow-up may assess:

• Distance visual acuity
• Near vision
• Spectacle prescription
• Cycloplegic refraction
• Axial length
• Pupil size
• Accommodation
• Eye pressure when indicated
• Ocular-surface health
• Adherence
• Side effects
• Outdoor and near-work habits

The International Myopia Institute regards axial-length measurement as an important outcome when the equipment is available because it directly assesses structural eye growth.

How Often Should the Child Be Reviewed?

Many children receiving atropine are reviewed every three to six months.

Earlier review may be needed when:

• Treatment has just started
• The concentration has been changed
• Side effects are present
• Progression has been rapid
• The child is very young
• Combination therapy is being used
• Vision has changed unexpectedly

The exact interval should be individualised.

How Do We Know Whether Atropine Is Working?

The clinician compares the child’s progression with:

• Previous untreated progression
• Expected progression for the child’s age
• Cycloplegic prescription changes
• Axial-length changes
• Treatment adherence
• Population growth data

A treatment response is not judged by whether the prescription remains completely unchanged.

Successful control may mean that the child still progresses, but more slowly than expected.

What Is Considered an Inadequate Response?

Concerns may arise when:

• Myopia increases by approximately –0.50 D or more over a year
• Axial elongation remains faster than expected for age
• Progression is accelerating
• The child is moving rapidly towards high myopia
• Treatment appears ineffective despite consistent use

These figures are not absolute cut-offs.

Before increasing treatment, the clinician should confirm:

• The child is using the drops correctly.
• The bottle contains the intended concentration.
• The formulation has not expired.
• Measurements are reliable.
• Cycloplegia was used when appropriate.
• Axial length was measured on the same instrument.
• No treatment interruptions occurred.

Can We Identify “Responders” After a Few Months?

Not reliably in every case.

Axial length and refraction fluctuate, particularly over short intervals.

One faster six-month period does not necessarily prove that a child is a non-responder.

Treatment changes should usually be based on:

• Repeated measurements
• Reliable baselines
• Consistent adherence
• Age and expected growth
• A clear trend rather than one isolated result

Analyses of LAMP data have cautioned against overconfidently separating children into responders and non-responders based on early measurements alone.

What Can Be Done If Atropine Is Not Working Well Enough?

Options include:

• Confirming adherence
• Increasing the atropine concentration
• Changing to a more reliable formulation
• Adding myopia-control spectacles
• Adding orthokeratology
• Adding soft myopia-control contact lenses
• Reviewing more frequently
• Improving outdoor and near-work habits

The decision should be based primarily on axial growth and accurate refraction rather than on the spectacle number alone.

Can Atropine Be Combined with Myopia-Control Spectacles?

Yes.

Atropine can be used with specialised spectacle lenses because the two treatments act through different pathways.

This may be considered when:

• The child is young
• Progression is rapid
• One treatment provides insufficient control
• Contact lenses are unsuitable
• The family prefers a non-contact-lens approach

Evidence for spectacle-plus-atropine combinations is growing, but the added benefit varies according to spectacle design, atropine concentration and population.

Combination treatment should be prescribed because the child needs greater control—not simply because two treatments sound better than one.

Can Atropine Be Combined with Orthokeratology?

Yes.

This is currently one of the better-studied combinations.

Randomised studies have found that adding 0.01% atropine to orthokeratology can further reduce axial elongation compared with orthokeratology alone. The International Myopia Institute estimated a median additional two-year efficacy of approximately 0.12 mm across the available randomised combination trials.

The additional effect may be more noticeable during the earlier treatment period.

Combination therapy also adds:

• Cost
• Complexity
• Drop side effects
• More follow-up requirements

Can Atropine Be Combined with Soft Contact Lenses?

Yes, although the evidence is less extensive than for atropine combined with orthokeratology.

It may be considered when a child:

• Uses daytime myopia-control contact lenses successfully
• Continues to elongate rapidly
• Has a high risk of severe myopia
• Tolerates atropine

The cornea and tear film must continue to be monitored because atropine does not remove contact-lens-related risks.

How Long Does Atropine Treatment Continue?

Treatment often continues for several years.

The duration depends on:

• Age at onset
• Current age
• Recent axial growth
• Recent refractive progression
• Pubertal development
• Previous rebound
• Concentration
• Treatment tolerance
• Family preference

Myopia does not automatically stop at puberty. Some teenagers and young adults continue to progress.

Treatment should therefore be guided by measured stability rather than stopped at a fixed birthday.

Should Treatment Stop Once the Prescription Is Stable for Six Months?

Usually not.

Six months may be too short to establish that eye growth has genuinely stabilised.

Progression can vary with:

• Age
• Season
• Growth spurts
• Measurement variation
• School workload
• Treatment adherence

Several consecutive stable measurements are more reassuring than a single stable visit.

What Is Rebound?

Rebound is faster myopia progression after atropine is stopped.

It does not mean that the child has become addicted to atropine.

Instead, the underlying tendency for eye growth may still be active when treatment is withdrawn.

Rebound tends to be greater with:

• Higher atropine concentrations
• Younger age when treatment stops
• More active progression before stopping
• Abrupt cessation
• Higher baseline myopia in some studies

The International Myopia Institute found that many of the larger rebound effects reported across myopia-control trials involved atropine or red-light therapy.

What Did the LAMP Studies Show About Stopping?

During the third year of LAMP, children who continued treatment progressed less than children who stopped.

The study found that:

• 0.05% remained the most effective concentration.
• Rebound differences between the low concentrations were relatively small.
• Younger children experienced more progression after stopping.
• Stopping at an older age was associated with less rebound.

At five years, many children who had stopped treatment required atropine to be restarted because progression resumed. Restarting 0.05% atropine produced efficacy similar to continued treatment.

Should Atropine Be Tapered Rather Than Stopped Suddenly?

Tapering may be considered, particularly for:

• Younger children
• Children using 0.05% or a stronger concentration
• Children with previous rapid progression
• Children who previously rebounded

The 2026 eight-year LAMP report found that children who tapered experienced approximately 0.25 D less progression over three years than those who stopped abruptly. The authors noted that the clinical importance of this difference remains uncertain.

Possible tapering strategies include:

• Reducing the concentration
• Reducing dosing frequency
• Combining both approaches
• Continuing optical myopia control during withdrawal

There is no single universally accepted tapering schedule.

Does 0.01% Cause Less Rebound?

Generally, rebound has been less pronounced with lower concentrations than with traditional high-dose atropine.

The CHAMP four-year trial reported negligible rebound after stopping its 0.01% formulation following three years of treatment.

However, a lower rebound risk does not necessarily compensate for inadequate treatment effect during the years when the child is progressing.

The total result over treatment and withdrawal matters more than rebound alone.

Can Atropine Delay Myopia Before It Starts?

Atropine has been studied in pre-myopic children who are not yet conventionally myopic but are at high risk.

In a randomised trial involving children aged four to nine, nightly 0.05% atropine reduced the incidence of myopia and fast myopic shift over two years. Atropine 0.01% did not differ significantly from placebo.

This does not mean that every child with myopic parents should receive atropine.

Preventive treatment should consider:

• Cycloplegic refraction
• Remaining hyperopic reserve
• Age
• Axial length
• Parental myopia
• Rate of refractive change
• Outdoor exposure
• Risk of early onset

Longer-term evidence is still needed to determine whether treatment permanently prevents myopia or mainly delays its onset.

At What Age Can Atropine Be Started?

Clinical trials have included children as young as four years.

Treatment may occasionally begin earlier or later according to the clinical situation, but very young children require careful assessment because early high myopia may be associated with:

• Prematurity
• Retinal disease
• Lens abnormalities
• Corneal conditions
• Connective-tissue disease
• Genetic syndromes

The younger the child, the more important it is to confirm the diagnosis and investigate unusually severe or rapidly progressive myopia.

Can Teenagers Use Atropine?

Yes.

Teenagers may continue to benefit while their prescription or axial length is still increasing.

Treatment should not be stopped simply because the child has entered secondary school.

The expected benefit may become smaller as natural eye growth slows, but treatment can remain worthwhile when progression continues.

Can Adults Use Atropine for Progressive Myopia?

The strongest evidence concerns children and adolescents.

Young adults may continue progressing, but there is less clinical-trial evidence defining:

• Optimal concentration
• Treatment duration
• Effectiveness
• Side effects
• Stopping strategy

Adult progression should also prompt assessment for:

• Keratoconus
• Lens-related refractive change
• Diabetes
• Medication effects
• Pathological myopia
• Other causes of refractive instability

How Should Atropine Be Stored?

Follow the product label and pharmacy instructions.

Singapore HealthHub advises:

• Store the medication in a cool, dry place.
• Keep it away from direct sunlight.
• Keep it out of reach of children.
• Discard it one month after opening or according to the medication label.

Some compounded or single-dose preparations have different:

• Expiry dates
• Refrigeration requirements
• Preservatives
• Packaging
• Discard instructions

Do not assume that every atropine bottle is stored in the same way.

Does the Formulation Matter?

Yes.

Atropine preparations may differ in:

• Concentration accuracy
• pH
• Preservatives
• Stability
• Bottle design
• Storage requirements
• Shelf life

This may partly explain why trials using the same nominal concentration have sometimes produced different results.

Medication should come from a reliable medical and pharmacy supply chain. Do not purchase unverified atropine from informal online sellers.

Can Siblings Share the Same Bottle?

No.

Each child should use medication prescribed specifically for them.

Sharing bottles risks:

• Contamination
• Incorrect concentration
• Dosing errors
• Confusion over expiry dates
• Inadequate monitoring

What If My Child Refuses the Drops?

Possible reasons include:

• Stinging
• Fear
• Light sensitivity
• Near blur
• Dislike of the routine
• Difficulty keeping the eye open

Helpful approaches include:

• Applying the drop while the child lies down
• Using a consistent bedtime routine
• Allowing the drop to fall into the inner corner of the closed eyelids in selected children, then asking them to blink it in
• Rewarding cooperation
• Explaining the purpose in age-appropriate language
• Reviewing whether another formulation is more comfortable

Do not physically struggle in a way that risks injuring the child’s eye with the bottle tip.

Can Atropine Be Used with Other Eye Drops?

Often, yes.

Separate different eye drops by approximately five to ten minutes unless instructed otherwise.

Tell the clinician about:

• Allergy drops
• Dry-eye drops
• Glaucoma medication
• Antibiotics
• Steroids
• Dilating drops
• Traditional or herbal eye preparations

Using several drops at the same time can wash one medication out of the eye.

Can Atropine Be Used During an Eye Infection?

The prescribing clinician should be informed if the child develops:

• Redness
• Pain
• Discharge
• Light sensitivity
• Corneal infection
• Significant allergy

The drops may need to be paused depending on the diagnosis.

Atropine should not delay urgent assessment of a painful red eye.

When Should Parents Seek Prompt Medical Advice?

Arrange prompt review for:

• Persistent or severe light sensitivity
• Significant near blur
• Headaches interfering with school
• Eyelid swelling or rash
• Painful red eye
• Sudden reduced vision
• Unequal pupil changes
• Fast or irregular heartbeat
• Facial flushing
• Confusion or unusual behaviour
• High fever
• Accidental ingestion
• Rapid progression despite consistent treatment

Frequently Asked Questions

Is atropine a steroid?

No.

Atropine is an antimuscarinic medication. It is not a steroid and does not share the same long-term side-effect profile as steroid eye drops.

Is atropine an antibiotic?

No.

It does not treat bacterial infection.

Does atropine cure myopia?

No.

It slows progression but does not reverse existing axial myopia.

Will my child still need glasses?

Yes.

Atropine does not correct distance blur.

Does atropine weaken the eyes?

No.

It alters eye-growth signals and temporarily affects the pupil and focusing system. It does not make the eyes lazy or weak.

Is 0.05% always better than 0.01%?

It is generally more effective on average but may cause greater light sensitivity and near blur.

The best concentration balances control and tolerance.

Why not use 1% if it is stronger?

Atropine 1% produces much greater pupil dilation, near blur and rebound. Most children would require additional optical support and experience more disruption to daily activities.

Can the drops change the eye colour?

No.

The pupils may appear larger, making the iris look different temporarily, but atropine does not change iris pigmentation.

Why are my child’s pupils different sizes?

Differences may occur if:

• A drop missed one eye
• One eye received more medication
• The child rubbed one eye
• The formulation entered the eye unevenly

A persistent new unequal pupil size—particularly with drooping eyelid, double vision, headache or neurological symptoms—requires assessment.

Should the drops be used only during school terms?

Usually not.

Eye growth continues during holidays.

Repeated stopping and restarting may reduce treatment consistency.

Can we stop during an overseas holiday?

Treatment can usually continue during travel if the drops are stored correctly.

Discuss travel plans when:

• Refrigeration is required
• The bottle may expire
• The family is crossing time zones
• Replacement medication may be difficult to obtain

Does my child need a break from atropine every year?

There is no established need for an annual drug holiday.

Stopping should be based on progression and clinical assessment.

Can atropine be used in only one eye?

It may be used in one eye in selected cases of unequal myopia or unilateral progression.

Most children with bilateral progressing myopia receive drops in both eyes.

Can atropine be used with orthokeratology?

Yes.

This may provide additional control in selected children whose axial length continues to increase.

Can atropine cause retinal damage?

Low-concentration atropine has not been shown to cause retinal damage in the major clinical trials.

Long-term monitoring remains appropriate because treatment may continue for several years.

Will the treatment affect colour vision?

Low-concentration atropine does not usually alter colour vision.

Can my child play sports after using atropine?

Yes.

Sunglasses or tinted lenses may help during bright outdoor sport.

Is atropine safe for long-term use?

Available trials—including five- and eight-year follow-up from LAMP—have been reassuring overall, although children require continued monitoring and the evidence is stronger for certain populations and formulations than others.

A Practical Atropine Treatment Plan

Before Starting

• Confirm the prescription with appropriate refraction.
• Measure axial length when available.
• Assess pupil size and near focusing.
• Examine the anterior chamber and ocular surface.
• Review allergies and medical history.
• Discuss other myopia-control options.

During the First Weeks

Monitor for:

• Stinging
• Light sensitivity
• Near blur
• Headache
• Eyelid allergy
• Difficulty following the routine

At Follow-Up

Measure:

• Visual acuity
• Refraction
• Axial length
• Pupil response
• Near focusing
• Eye pressure when indicated
• Ocular-surface health

When Control Is Inadequate

Consider:

• Confirming adherence
• Increasing concentration
• Changing formulation
• Adding myopia-control spectacles
• Adding contact-lens treatment
• Shortening the review interval

When Considering Stopping

Assess:

• Age
• Recent prescription trend
• Recent axial growth
• Pubertal stage
• Previous rebound
• Treatment concentration

Consider gradual tapering and continue monitoring after cessation.

Common Myths About Atropine

“The lowest dose is always safest and therefore best.”

Lower concentrations usually cause fewer side effects, but inadequate control allows more axial elongation.

Safety includes preventing excessive eye growth as well as minimising temporary side effects.

“If the prescription still increases, atropine has failed.”

No treatment stops every child completely.

The child may still be progressing substantially less than they would without treatment.

“Atropine means the child no longer needs outdoor time.”

Outdoor time and healthy near-work habits remain important.

“Atropine is dangerous because it can be poisonous.”

Atropine can cause toxicity if swallowed or used inappropriately. The small ophthalmic dose used under medical supervision is generally well tolerated.

“Once atropine starts, it can never be stopped.”

Treatment can be stopped, but timing and tapering should be planned because myopia may resume progressing.

The Bottom Line

Atropine eye drops are an established treatment for slowing childhood myopia.

They work primarily by reducing excessive axial elongation rather than by correcting blurred vision.

The most commonly studied low concentrations are:

• 0.01%
• 0.025%
• 0.05%

Among these, 0.05% has generally shown the strongest effect in the LAMP trials, while 0.01% has produced mixed results between different studies and formulations.

Possible side effects include:

• Larger pupils
• Light sensitivity
• Near blur
• Stinging
• Headache
• Eyelid allergy

Serious systemic effects are very rare when the drops are used correctly but may occur with accidental swallowing or excessive dosing.

Atropine should be monitored using:

• Visual acuity
• Accurate refraction
• Axial length
• Side-effect assessment
• Adherence
• Ocular examination

Treatment often continues for several years. Younger children may require stronger or longer treatment, and gradual tapering may be considered when stopping.

Atropine may be combined with specialised spectacles or contact-lens treatments when eye growth remains rapid.

The aim is not to eliminate glasses today. It is to reduce how long the eye becomes during childhood and protect the child’s vision for the decades ahead.

References

1. Bullimore MA, et al. IMI—Interventions for Controlling Myopia Onset and Progression 2025. Investigative Ophthalmology & Visual Science. 2025.
2. Singapore HealthHub. Atropine Eye Drop. Reviewed May 2026.
3. Yam JC, et al. Low-Concentration Atropine for Myopia Progression Study: A Randomised, Double-Masked, Placebo-Controlled Trial. Ophthalmology. 2019.
4. Yam JC, et al. Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression Study. Ophthalmology. 2020.
5. Yam JC, et al. Three-Year Clinical Trial of Low-Concentration Atropine: Continued Treatment Versus Washout. Ophthalmology. 2022.
6. Zhang XJ, et al. Five-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression. Ophthalmology. 2024.
7. Zhang Y, et al. Eight-Year Results of the LAMP Randomised Clinical Trial: Tapering Versus Stopping Atropine. JAMA Ophthalmology. 2026.
8. Li FF, et al. Differential Effects on Ocular Biometrics by 0.05%, 0.025% and 0.01% Atropine. Ophthalmology. 2020.
9. Zadnik K, et al. Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Paediatric Myopia Progression: The CHAMP Trial. JAMA Ophthalmology. 2023.
10. Year-Four Results from the CHAMP Phase 3 Clinical Trial. 2026.
11. Repka MX, et al. Low-Dose 0.01% Atropine Eye Drops Versus Placebo for Myopia Control in US Children. JAMA Ophthalmology. 2023.
12. Yam JC, et al. Effect of Low-Concentration Atropine Eyedrops Versus Placebo on Myopia Incidence in Children. JAMA. 2023.
13. Li FF, et al. Age Effect on Treatment Responses to 0.05%, 0.025% and 0.01% Atropine. Ophthalmology. 2021.
14. Kinoshita N, et al. Efficacy of Combined Orthokeratology and 0.01% Atropine for Slowing Axial Elongation: A Two-Year Randomised Trial.