Low-dose atropine for myopia: the first month

Key takeaways

Low-dose atropine is meant to slow short-sightedness in a growing child. It does not cure or reverse it, and glasses are still needed.
The drops are given once nightly in both eyes at bedtime (AAO), and the large trials used the same pattern.
In the LAMP study, bright-light pupils were larger by 0.49 mm at 0.01%, 0.76 mm at 0.025% and 1.03 mm at 0.05%, against 0.13 mm with placebo. Near-focus loss grew with the strength.
Allergy is the main uncommon effect. In ATOM2, allergic conjunctivitis and dermatitis occurred in the 0.1% and 0.5% groups and not at 0.01%.
The first review checks refraction and axial length, with pupil size, near focus and vision. A stop is planned with the doctor, not decided alone.

In the first month of low-dose atropine, most children notice little. The effects reported in trials are slightly larger pupils, mild glare in bright light and, at the 0.025% and 0.05% strengths, some blur up close. The drops are meant to slow short-sightedness, not cure it, and the first review checks for exactly these effects.

This page covers what the drops are for, how they are given, what trials report in the early weeks, what is uncommon, practical tips, what the first review measures, when to call, and how stopping is planned. It sets out published findings. The strength and plan come from your child's eye doctor, and the efficacy numbers live in atropine drops for myopia: what the numbers say.

What are low-dose atropine drops for?

They are for slowing short-sightedness (myopia) in a growing child. They do not cure it, they do not reverse it, and they do not remove the need for glasses. The American Academy of Ophthalmology says that when given in small amounts for 2 to 3 years, atropine eye drops may slow the progression of myopia, and that doctors do not know exactly how they work but think they may keep the eye from lengthening too much.

Myopia worsens as the eye grows longer, which is why axial length (the front-to-back length of the eye) is measured at review. If the diagnosis itself is new, slowing myopia down: drops, lenses and honest numbers sets out the other options, and eye drops that "cure" short-sightedness explains why the word cure does not apply.

How are the drops given?

One drop in each eye at bedtime, every night. The AAO describes the drops as placed in the eye each night at bedtime, and in the large trials the children had the drops once nightly in both eyes. The AAO says low-dose atropine is used for children between 5 and 18 years old.

Tying the drop to bedtime makes it a routine that is easy to keep. The action: put the drop in after teeth are brushed and just before lights out, wash the hands first and after, close the eye for a minute, and keep the bottle with the other medicines, out of children's reach.

What happens in the first few weeks?

Most of what trials report is a small change in the pupil and in near focus, and it depends on the strength. In the Hong Kong LAMP study, 438 children aged 4 to 12 had 0.05%, 0.025% or 0.01% atropine or placebo each night for a year, and pupil size and focusing were measured at baseline, 2 weeks, 4 months, 8 months and 12 months.

At 12 months the pupil in bright light was larger by 1.03 mm at 0.05%, 0.76 mm at 0.025% and 0.49 mm at 0.01%, against 0.13 mm with placebo. The focusing reserve (accommodation amplitude) was reduced by 1.98 D at 0.05%, 1.61 D at 0.025% and 0.26 D at 0.01%, against 0.32 D with placebo.

So at 0.01% the focusing change was about the same as with placebo, and it grows with the strength. Visual acuity and vision-related quality of life were not affected in any group, and all strengths were well tolerated.

These are group averages measured over a year, not a day-by-day diary of the first month, so an individual child may notice more or less. The earlier ATOM2 trial in Singapore used 0.5%, 0.1% and 0.01% and found that 0.01% had a negligible effect on accommodation and pupil size and no effect on near visual acuity.

Is light sensitivity or blurred reading normal at the start?

Yes, a little of both is expected, more at higher strengths. A larger pupil lets more light in, so a bright afternoon, a car headlamp or a phone screen can feel glaring. A weaker focusing reserve can make small print or a book held close look soft. The LAMP measurements above are the reason doctors check for them at the first review.

Larger pupils are the reason bright light can feel glaring. The AAO page on myopia control mentions redness or itchiness around the eye as side effects of low-dose drops. Ask the eye doctor which of these to expect at your child's strength, and write down what the child says during the first two weeks, in the child's own words.

What side effects are uncommon?

Allergy is the main one. In ATOM2, allergic conjunctivitis and dermatitis were the most common adverse effects, with 16 cases in the 0.1% and 0.5% groups and none in the 0.01% group. An allergy looks like red, itchy, swollen or crusty eyelids and skin around the eye.

Wash the hands, avoid touching the dropper tip to the eye or lashes, and tell the doctor about any red or itchy lids so the drops can be reviewed. Pink eye in children helps tell an infection from an allergy, but the doctor should decide, because the drops are a medicine.

What can I do to make the first month easier?

Ordinary comfort measures cover most of it. These are everyday tips, not trial findings.

Sunglasses or a wide-brimmed hat for outdoor play, because a larger pupil makes bright light feel harsher. Outdoor time is still worth keeping; two hours outside explains why.
Good light for reading, and the page held at a comfortable distance. If small print looks soft, a larger font or a short break helps.
The same time every night, so the drop becomes part of the routine and none is missed.
Keep wearing the glasses the doctor prescribed. The drops do not replace them.

Bring the glasses and the bottle to every review so the doctor can see what is being used.

What is measured at the first review?

Refraction (the glasses number) and axial length are the two measurements that show whether the eye is growing more slowly, and the doctor also checks pupil size, near focus and vision. The LAMP and ATOM2 trials measured refraction with the pupils dilated (cycloplegic refraction), axial length, accommodation, pupil diameter and acuity. ATOM2 checked at 2 weeks and then every 4 months.

One review does not show whether the drops are working. Axial length and refraction need several months to compare, which is why reviews are spaced. For what the numbers mean, reading your child's myopia prescription is the companion page. The action: write down the date of the first drop and take the child to every scheduled review, even when the child feels fine.

When should I call the eye doctor?

Call if the child has red, swollen or itchy eyelids, eye pain, a headache that keeps returning, glare or blur that does not ease after the first weeks, or if the drops are swallowed or a dose is doubled by mistake. Go to an eye casualty the same day for sudden eye pain, a sudden loss of vision, or if the child seems unwell after a dose.

Do not stop the drops yourself because the child dislikes glare; call first, because a change of strength or timing may help. The doctor may adjust the plan rather than abandon it.

What happens when we stop the drops?

Stopping is a planned decision, not a sudden stop. The AAO describes use over 2 to 3 years, and the eye doctor decides the length for your child. When can we stop myopia treatment explains the rebound that can follow and how a stop is planned.

Until then, the aim of the first month is simple: get the routine in place, notice any side effects early, and attend the first review with the child's own description of what the eyes feel like.

Call the eye doctor sooner if your child…

Has red, swollen or itchy eyelids or skin around the eye.
Has eye pain, or a headache that keeps coming back.
Has glare or blurred reading that does not ease after the first weeks.
Has swallowed the drops, or had a double dose by mistake.
Has sudden eye pain, sudden loss of vision, or seems unwell after a dose: go to an eye casualty the same day.

Is this urgent? Today, this week or routine

Common questions

What are low-dose atropine eye drops for in children?

They are for slowing short-sightedness (myopia) in a growing child, not curing it. The AAO says that when given in small amounts for 2 to 3 years, atropine eye drops may slow the progression of myopia. Glasses are still needed.

How are atropine drops for myopia given?

One drop in each eye at bedtime, every night. The AAO says the drops are placed in the eye each night at bedtime, and the LAMP and ATOM2 trials used once-nightly drops in both eyes.

What are the side effects of low-dose atropine in the first month?

The effects measured in trials are larger pupils and a smaller focusing reserve, both growing with the strength. In LAMP, bright-light pupils were larger by 0.49 mm at 0.01%, 0.76 mm at 0.025% and 1.03 mm at 0.05%. The AAO also mentions redness or itchiness around the eye.

Will atropine drops make my child sensitive to light?

A larger pupil lets in more light, so bright light can feel glaring, more at higher strengths. Sunglasses or a hat help outdoors. ATOM2 found that 0.01% had a negligible effect on pupil size. Tell the doctor if glare does not ease.

Will atropine make my child's reading blurry?

It can at higher strengths. In LAMP, accommodation amplitude fell by 1.98 D at 0.05%, 1.61 D at 0.025% and 0.26 D at 0.01%, against 0.32 D with placebo. Visual acuity and quality of life were not affected in any group.

Can my child be allergic to atropine drops?

Yes, though it is uncommon at low doses. In ATOM2, allergic conjunctivitis and dermatitis were the most common adverse effects, with 16 cases in the 0.1% and 0.5% groups and none at 0.01%. Red, itchy or swollen eyelids should be reported to the doctor.

What is checked at the first review after starting atropine?

Refraction and axial length, which show how fast the eye is growing, plus pupil size, near focus and vision. The LAMP trial measured these at 2 weeks, 4 months, 8 months and 12 months, and ATOM2 at 2 weeks and then every 4 months.

the reference pages Myopia control in Malaysia →

References

Ophthalmology 2019 · Low-Concentration Atropine for Myopia Progression (LAMP) Study, phase 1 randomised placebo-controlled trial (Yam et al.) · pubmed.ncbi.nlm.nih.gov
Ophthalmology 2020 · Two-Year Clinical Trial of the LAMP Study: Phase 2 Report (Yam et al.) · pubmed.ncbi.nlm.nih.gov
Ophthalmology 2012 · Atropine for the Treatment of Myopia 2 (ATOM2), safety and efficacy of 0.5%, 0.1% and 0.01% doses (Chia et al.) · pubmed.ncbi.nlm.nih.gov
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.

Starting low-dose atropine for myopia: what to expect in the first month