Orthoptic uses of atropine

Why has my child been prescribed atropine ointment / drops?

Your ophthalmologist has prescribed your child atropine, after speaking with your orthoptist. They made this decision for one of the following reasons.

1. As an alternative to patching treatment. To improve the vision of your child’s lazy eye. If your child has refused patching, we may prescribe atropine ointment / drops.

   You (the parent / carer) will instil the ointment / drops once or twice a day, into your child’s good eye only. The ointment / drops will constantly blur the near vision of the good eye, encouraging your child to use their 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. They may need to do this to make sure your child's eye is developing normally and to test if they need glasses.

   Your ophthalmologist may have decided to give atropine for one of the following reasons.

   • Your child's pupils may not have dilated sufficiently with the Cyclopentolate drops at a previous appointment. Especially if your child's eyes are dark in colour.

   • There may have been problems instilling drops / ointment in the clinic, causing distress to your child.

   If atropine is needed before an eye examination, it is usually instilled into both eyes:

   • once the night before your child's appointment; and

   • again in the early morning of the appointment (unless we tell you otherwise).

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

• The pupil will dilate (the central black part of the eye will become 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, tell their teacher that they are using eye drops / ointment. The blurred vision may interfere with their school 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 7 days after the last instillation. Your child's pupil may remain dilated for up to 14 days.

Are there any side effects?

Yes. The dilated pupil will cause sensitivity to light. Avoid bright lights where possible. If appropriate, use a sun hat.

Atropine ointment / drops is a poison if taken by mouth. Be very careful when using it.

The side effects are rare but may include the following.

• 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. 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) into.

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 using drops, make sure you press gently on the inner corner of the eye for 1 minute. This will stop the medicine running into your child's nose, causing them to swallow the atropine. Swallowing the atropine may increase the chance of side effects.

6. Wash your hands after using the drops. Doing this will stop 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 / 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. The reason affects how often you instil the ointment / drops. It will also be written on the packaging from the pharmacy.

• 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).

• Before an eye examination

  Instil atropine into both eyes once on the day before your appointment.

  Instil atropine into both eyes once early on the morning of your appointment.

Important information

• Do not use atropine beyond the expiry date.

• Do not use atropine after it has been opened for 4 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?

Treatment with atropine needs to be closely monitored. To start with, you will have appointments every 2 weeks at the Orthoptic Department.

What if I have any questions or concerns?

Remember that your orthoptist is here to help, advise, and support you during your child’s treatment. If you have any worries or questions, contact the Orthoptic Department on 01227 868615.

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