Atropine Drops for Myopia: 5 Things You Should Know

Atropine drops for myopia are currently the most effective therapy for myopia control.

The number of people with myopia (also known as nearsightedness) is increasing globally. The cause for this is a combination of less outdoor activity, less sun exposure, and more use of electronic devices for long periods of time.

Once you become nearsighted as a child and get your first pair of glasses, your distance vision tends to get worse over time. However, there are ways to slow down the progression of myopia. Atropine is the most promising today.

In this article, we’ll go over 5 things you should know about atropine drops for myopia:

What Is Atropine?

Atropine is a very interesting medication. Not only in how it works, but also in the ways in which it can be used.

It appears naturally in some plants. For medical uses, it is refined and concentrated.

In a nutshell, it works by weakening the contractions of involuntary muscles. It also has other neurological effects. There are many medical uses for this. However, to keep this article simple, we will focus exclusively on how atropine can be helpful in eye care.

What Are Atropine Eye Drops For?

Atropine eye drops weaken the contractions of the involuntary muscles within the eye that operate the size of the pupil (iris muscle) and the shape of the lens (ciliary muscle). This is helpful during eye examinations to get the most accurate measurements.

Let’s further explore how atropine affects these muscles:

Paralyzes the Ciliary Muscle

The ciliary muscle is an involuntary muscle that is responsible for accommodation. Accommodation is when the lens of the human eye changes shapes to adapt depending on if you are looking at close objects or distant objects.

The ciliary muscle adjusts the accommodation automatically, without you needing to consciously think about it. Atropine temporarily paralyzes this muscle and the accommodation reflex.

atropine drops for myopia

When you put atropine drops in your eyes, the ciliary muscle stays relaxed. This means if you bring an object close to your eye, the image moves behind the retina causing you to see that close object blurry. For clear vision, the image needs to focus exactly on the retina.

Normally, the image doesn’t become blurry because the ciliary muscle squeezes the lens to a more round shape, moving the image back to the retina and making vision clear.

Paralyzing the ciliary muscle helps eye doctors determine the true refractive error of the eye, as accommodation can skew eye test measurements.

Dilates the Pupils

Atropine eye drops are also used during eye examinations to dilate the pupil. When it’s dark, your eyes’ pupils automatically grow to allow you to receive more visual information. When it’s sunny and there’s a lot of light, the pupil gets smaller.

Paralysis of the iris prevents the pupil from adjusting to the brightness of light. This allows doctors to examine the retina and other deep structures of the eye more accurately.

atropine drops for myopia

How Do Atropine Drops Help Myopia?

Myopia is caused by unnatural elongation of the eyeball or curvature of the cornea such that light no longer focuses directly on the retina. Instead, the light focuses in front of the retina, making distant objects appear blurry.

The retina is located in the back of the eye and is responsible for translating light into an image that the brain can read.

myopia explained

Since atropine eye drops relax the ciliary muscle, it makes the lens of the eye flatter. This can help to move the focal point of the light further back to the retina, which is where we want it for clear vision.

Based on this review of 17 clinical studies, there’s strong evidence supporting the use of atropine to prevent myopic progression. It’s considered one of the most effective ways to control myopia progression as of today.

In most clinical studies addressing atropine drops for myopia, they gave children eye drops in both eyes every other day.

We can safely say that the start of myopia happens because of a combination of genetic factors and poor vision and lifestyle habits. But, the reason why myopia keeps getting worse after you get your first pair of glasses is still a mystery. There are many theories for why it happens. Personally, I think the Peripheral Hyperopic Defocus Theory is the most interesting one.

With that said, doctors also don’t know for sure why atropine seems to hold back myopia. But the hypothesis is it attaches to certain growth receptors in the eyes, blocking the stimulation that produces the elongation of the eyeball.

Atropine Concentration

Atropine drops for myopia come in different concentrations. The concentrations that have been researched are 0.01% up to 1%.

This number represents the amount of actual atropine in the eye drops. The rest is usually a solution that matches the natural liquids produced by the eye and lubricates it.

Different doses of atropine are effective at slowing down the progression of myopia, likely by limiting the elongation of the eyeball.

Higher doses seem to have a stronger effect. However, after the treatment stops it’s common for myopia to progress quickly back up again.

This seems to be minimized by using low doses (especially atropine 0.01%). Lower doses also seem to have less side effects:

Are Atropine Eye Drops Safe?

The United States FDA has approved atropine for the treatment of lazy eye, but not for controlling the progression of myopia.

The most frequently reported side effects in the reviewed studies of atropine drops for myopia were:

  • Intolerance to bright light
  • Near objects appear blurry
  • Allergic reaction
  • Rebound of myopia progression after the treatment stops

More Research Needed

Atropine drops for myopia need more research. Most of the evidence is from Asian children. It may not be generalizable to other populations.

Future research should address the use of atropine in young adults from different populations. It should also look at the side effects of long-term use and increased exposure of the lens and retina to ultraviolet light.

Conclusion — Atropine Drops for Myopia

Atropine eye drops are the most likely effective treatment to slow myopia progression. However, we don’t know the exact reason why it works.

Doses with lower concentrations seem to reduce the side effects, but we need more research in more diverse populations.

We hope this article helped you understand the use of atropine eye drops for myopia. If you have any questions don’t hesitate to leave them in the comments below!

Hugo Moreira

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My passion for promoting eye health in communities around the world fuels me to create content that is factually reviewed not only by the most up-to-date scientific research but also by everyday expertise from my personal experience with being nearsighted since I was a child.