Orthoptic uses of atropine

Why should my child use the atropine ointment / drops?

Your child has been prescribed atropine by your ophthalmologist after consultation with your orthoptist for one of the following reasons.

1. As an alternative to patching treatment. To improve the vision of your child’s lazy eye. In the few exceptional cases where patching has been refused by your child, atropine ointment / drops may be prescribed.
   
   The ointment / drops are instilled by you (the parent) once or twice daily, into your child’s good eye only. They act to constantly blur the near vision of that eye, to encourage the use of the lazy eye.

2. For an eye examination. To allow the eye specialist (ophthalmologist or optometrist) to look at the back of your child’s eye, to make sure their eye is developing normally and to test if they need glasses. The decision to give atropine may have been made by your ophthalmologist because:
   
   - the pupils may not have dilated sufficiently with the cyclopentolate drops at a previous visit, especially if the eyes are dark in colour, or
   
   - there may have been problems instilling drops / ointment in the clinic, causing distress to your child.
   
   In this case, the atropine is usually instilled into both eyes, once the night before their appointment and again in the early morning of their appointment (unless told otherwise), if needed before an eye examination.

What will happen to my child’s eye / vision when we use atropine?

• Pupil dilation, the central black part of the eye is enlarged. This may cause glare from bright lights.

• Cycloplegia (prevents focussing) during the course of treatment. This will cause blurring of near print.

If your child goes to school or nursery you should tell their teacher that they are using eye drops / ointment, as their blurred vision may interfere with their close work (for example reading and writing).

How long do the effects of the atropine last?

The blurred vision, caused by the atropine, will last for approximately seven days after the last instillation. The pupil may remain dilated for up to 14 days.

Are there any side effects?

Yes. The dilated pupil will cause sensitivity to light, so avoid bright lights where possible and use a sun hat, if appropriate. Atropine ointment / drops is a poison if taken by mouth, so be extremely careful when using it.

The side effects are rare but may include:

• dry mouth and sore throat

• headache

• redness around the eyes and flushing of the skin

• fever and raised temperature

• irritability

• nausea (feeling sick) and vomiting.

If you notice any of these side effects, stop the atropine immediately and contact your doctor or the Orthoptic Department.

What should I do before using atropine?

• Do not use atropine if your child has a heart defect or high fever.

• Make sure that you tell the ophthalmologist and orthoptist of any other medication your child is taking.

How should I instil the atropine ointment / drops?

1. Wash your hands before you start.

2. With your finger, gently pull down the lower eyelid of the eye you are instilling the drop(s) in to.

3. Instil one drop of atropine or squeeze a little ointment (match-head size) into the area between the eyeball and lower eyelid.

4. Release the eyelid.

5. If drops are used, make sure you press gently on the inner corner of the eye for one minute, to prevent the medicine running into your child's nose and being swallowed, as this may increase the chance of side effects.

6. Wash your hands after using the drops, to prevent you from accidentally taking some internally.

It may be easier to instil the atropine while your child is sleeping.

What should I do if I forget a dose?

Instil the eye drops or apply the eye ointment as soon as you remember the missed dose. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not instil or apply a double dose to make up for a missed one.

How often should I use atropine?

Please note carefully why your child is having the atropine, as this affects how often you instil the ointment / drops. It will also be written on the packaging from the pharmacy.

1. To treat a lazy eye

   Instil atropine into: Right eye once or twice daily (as advised)

   Instil atropine into: Left eye once or twice daily (as advised)

2. Before an eye examination

   Instil atropine into: Both eyes once, the day before your appointment and once early on the morning of your appointment.

Important information

• Do not use the atropine beyond the expiry date.

• Do not use it after it has been opened for four weeks.

• Store the atropine upright in a dry place away from children, strong light, and below 25°C.

Warning: keep all medicines away from children. Atropine is poisonous if taken internally.

Will my child need a follow-up appointment?

This treatment needs to be closely monitored. It will need fortnightly visits to the Orthoptic Department to start with.

Further support

Remember that your orthoptist is here to help, advise, and support you during your child’s treatment. Do not hesitate to ask if you have any particular problems or worries, or if you have any further questions, contact the Orthoptic Department on 01227 868615.