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% to 0.05% qhs. Some advocate higher concentrations (e.g. 0.5%)
or higher initial concentrations for higher risk children or as a weekly or biweekly
treatment to improve compliance.1  Extended taper may be required.
Chem Specs atropine sulfate 0.5%, 1%, 2%
Quantities 2,5,15ml
Cost 45.00 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.
Myopia Prevention 2 year myopia progression with atropine qhs.
1% atropine.......−0.28±0.92 D
0.5%.....−0.30±0.60 D
0.1%.....−0.38±0.60 D
0.01%....−0.49±0.63 D
control...−1.20±0.69 D
Myopic progression however was least overall (−0.72±0.72 D) with the 0.01% group due to less
rebound progression 1 year after the end of treatment. (Am J Ophthalmol. 2014 Feb;157(2):451-457).
So the effect is dose dependent with evidence of a steroid-like rebound on abrupt cessation.
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. Shannon L. Risacher, PhD; Brenna C. McDonald, PsyD, MBA; Eileen F. Tallman, BS, et al. JAMA April 18, 2016.