click here for details           Atropine  (U.S.N.L.M.)
Dosing  (uveitis/iritis) 1 or 2 drops up to 4 times daily   (1% bid typically)
Dosing (cycloplegia) 1 or 2 drops 0.5% bid for 1 to 3 days before examination
(Consider cyclopentolate 1% administered 30 min before refraction.)
(Myopia prevention) 1 or 2 drops 0.01% - 0.05% qhs for mild progression3.
1 or 2 drops 0.5% or 1% weekly to qhs for strong progression.
Chem Specs atropine sulfate 0.5%, 1%, 2%
Quantities 2,5,15ml
Cost 35.00 5ml generic
Class anticholinergic
Action Competitive antagonist for the muscarinic acetylcholine receptor.
Usage Indicated for cycloplegic refraction or for pupil dilation in acute iritis and uveitis.
Used off label to prevent myopic progression.
Myopia Prevention Reduction in myopia progression is dose dependent, but myopia rebound after cessation
is also dose dependent1 such that 0.01% concentration resulted in the lowest overall
progression according to ATOM 24. Thus a higher dose treatment period followed by a
extended 0.01% taper period may ultimately prove to be optimal.
Photophobia and cycloplegia is generally absent at low concentrations (0.01% to 0.05%).
With higher concentrations (0.5% or 1%) these side effects should be addressed with
progressive and photochromic lenses.
Warnings Increased susceptibility in infants, young children, and in children with blond hair, blue eyes, Down's
syndrome, spastic paralysis, or brain damage. Ointment form thought to reduce systemic absorption.
Contraindications Primary glaucoma or a predisposition toward narrow angle glaucoma. Iris lens synechiae.
Pediatric patients who have previously had a severe systemic reaction to atropine. The elderly
and others where undiagnosed glaucoma or excessive pressure in the eye may be present.
Hypersensitivity to atropine or product contents.
Pediatric use > 3 months
Pregnancy Category C
Peak mydriasis 30-40 min. Peak cycloplegia 1-2 hrs. Recovery 6-12 days.
Nasolacrimal pressure recommended.
Compounding Note   Compounded 0.01% atropine typically labelled "0.1mg/ml atropine sulfate".
Systemic anticholinergics may be associated with increased risk of dementia.2
1. Virgilio GALVIS et. al., Med Hypothesis Discov Innov Ophthalmol. 2016 Autumn; 5(3): 78–88
2. Risacher, McDonald, Tallman, et al. JAMA April 18, 2016.
3. Jason C. Yam, et.al., LAMP January 2019, Volume 126, Issue 1, Pages 113–124
4. Chia, A., Chua, W.H., Wen, L. et al. Am J Ophthalmol. 2014; 157: 451–457 ATOM 2 5.