Atropine eye drops for myopia: side effects and what decides the cost

At low strengths the side effects of atropine eye drops for myopia are mostly a larger pupil (more glare), some blur up close, and occasional redness, itching or an allergic eyelid reaction, and they grow with the strength. The cost depends on the strength, the type of bottle, the visits and the glasses, and this page names no price.

Dr Chan Li Yen, paediatric ophthalmologist in Petaling Jaya, writes this journal and counts myopia control in children, low-dose atropine included, among her special interests; the About page says where she practises. The effect on myopia is in atropine drops for myopia: what the numbers say, and this page sets out the side effects by strength and what decides the cost.

What are the side effects of atropine eye drops for myopia?

The common ones follow from what the drug does. It widens the pupil and weakens the eye's focusing for near, so a child may notice more glare in bright light and some blur when reading. The American Academy of Ophthalmology (AAO) lists redness or itchiness around the eye as the side effect of low doses.

Allergy is the other one. In the ATOM2 trial of 400 children aged 6 to 12, allergic conjunctivitis and dermatitis occurred in 16 children on the 0.1% and 0.5% drops and in none on 0.01%. A red, swollen or itchy eyelid, or a rash around the eye, is a reason to stop and see the doctor.

Do the side effects get worse with a stronger drop?

Yes, they grow with the strength. The LAMP trial followed 438 children aged 4 to 12 for a year. In bright light the pupil widened by 0.49 mm on 0.01%, 0.76 mm on 0.025% and 1.03 mm on 0.05% atropine, against 0.13 mm with placebo. The focusing reserve of the eye, measured as accommodation amplitude, fell by 0.26 D on 0.01%, 1.61 D on 0.025% and 1.98 D on 0.05%, against 0.32 D with placebo.

The same trial found that visual acuity and vision-related quality of life were not affected at any strength, and that all three were well tolerated. ATOM2 found that 0.01% had a negligible effect on focusing and pupil size and no effect on near visual acuity. The stronger drops slowed myopia more in LAMP, which is why the strength is chosen with the doctor for each child and not by the lowest side effects alone.

What helps with glare and blurred reading?

The AAO says the drops go in at bedtime each night, and the timing is part of the plan, so keep to the hour the doctor sets. If glare or reading blur does not settle after the first weeks, tell the doctor, who can look at the strength and at whether reading glasses are needed.

Families often ask about photochromic or tinted lenses and a brimmed hat for glare outdoors. They are sensible, low-risk measures against bright light, but this page cites no trial that tested them, so ask the doctor what suits your child. The day-to-day picture of the early weeks is in low-dose atropine for myopia: the first month.

Are atropine eye drops safe for children?

At low strengths the trials found them well tolerated, but the long-term evidence is limited and the 2025 Cochrane review notes that adverse events were not reported consistently across trials. That is the reason these drops are used as a prescription medicine, with follow-up, and not bought and started on a parent's own.

See a doctor promptly for eye pain, a red or swollen eyelid, a rash, or glare or blur that is getting worse. Go to an eye casualty the same day for sudden pain or sudden loss of vision, or if a child seems unwell after a dose. A strongly short-sighted child who reports new floaters, flashes or a shadow across the vision also needs a prompt examination.

What happens to myopia when the atropine drops are stopped?

Myopia can speed up again for a time, which is called rebound, but in the longest trial the rebound was clinically small. In the third year of LAMP, children who stopped their drops progressed faster than those who continued: -0.68 D against -0.28 D for 0.05%, -0.57 against -0.35 D for 0.025%, and -0.56 against -0.38 D for 0.01%.

The authors found the rebound differences between strengths clinically small, and older age and a lower strength were linked to a smaller rebound. The Cochrane review found limited evidence on stopping. So a stop is planned with the doctor, and not decided at home. When can we stop myopia treatment sets out how that works.

What decides the cost of atropine eye drops for myopia in Malaysia?

The cost is decided by several things that are charged in different ways, so this page quotes no price. The AAO says the drops are used for 2 to 3 years, which means the monthly cost runs for a long time. The parts to ask about are:

• The strength: 0.01%, 0.025% and 0.05% were compared in LAMP, and the strength chosen decides which product is needed.
• The type of bottle: ready-made from a manufacturer or prepared by a pharmacy (compounded), and how long each bottle lasts once opened.
• The visits: the first examination with relaxing drops, and the follow-ups that check the prescription and the length of the eye.
• Glasses: a child on the drops still needs glasses for clear sight, updated as the prescription changes, and possibly reading glasses.
• Whether the drops are dispensed at the clinic or by a pharmacy, and who refills the prescription.

Which strengths are registered or supplied in Malaysia is a question for the prescribing doctor, and this page does not state it. Ask for a written estimate for a full year, using ten questions to ask before you pay for myopia control.

How long are the drops used?

The AAO says low-dose atropine may slow progression when given in small amounts for 2 to 3 years, from about age 5 to 18, each night. The LAMP trial ran for three years in its extension, and the right length for one child depends on age, how fast the prescription is rising and how the drops are tolerated. The doctor reviews this at each visit.

Common questions

the reference pages Myopia control in Malaysia →

References

1. Ophthalmology 2019 · Low-Concentration Atropine for Myopia Progression (LAMP) Study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control (Yam et al.) · pubmed.ncbi.nlm.nih.gov
2. Ophthalmology 2012 · Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2) (Chia et al.) · pubmed.ncbi.nlm.nih.gov
3. Ophthalmology 2022 · Three-year clinical trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study: continued versus washout, phase 3 report (Yam et al.) · pubmed.ncbi.nlm.nih.gov
4. Cochrane Database of Systematic Reviews 2025 · Interventions for myopia control in children: a living systematic review and network meta-analysis (Lawrenson et al.) · pubmed.ncbi.nlm.nih.gov
5. American Academy of Ophthalmology · Myopia control in children · www.aao.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.