Atropine Ointment
Atropine 1% · ophthalmic ointment
Mydriatics/Cycloplegics
Approved uses
Cycloplegic refraction
Small amount to the conjunctival sac once or twice a day.
Uncovers about 0.18 D more hyperopia than cyclopentolate 1%, with wide variation between individuals.
Pupillary dilation in inflammatory conditions of the iris and uveal tract
Small amount to the conjunctival sac once or twice a day.
OFF-LABELNot in the FDA label for this product
Myopia progression in children
1% ointment once daily for 1 year, the regimen used in the cited pilot.
Nonrandomized pilot · n=23
Nonrandomized pilot in 23 children aged 5 to 10 with myopia of -3.00 D or more, against 23 controls matched for age, sex, and baseline refraction: over 1 year myopic progression was +0.06 +/- 0.79 D versus -1.19 +/- 2.48 D (P = 0.005) and axial elongation 0.09 +/- 0.19 mm versus 0.70 +/- 0.63 mm (P = 0.004), with 1 allergic reaction among 23 treated. The authors concluded a large randomized trial with longer follow-up was still needed; the randomized evidence base for myopia control (ATOM2, LAMP) used low-concentration solutions, not this ointment.
Contraindications
- Primary glaucoma or a predisposition to narrow anterior chamber angle glaucoma.
- Pediatric patients who have previously had a severe systemic reaction to atropine.
- Hypersensitivity to any component of this preparation.
Available FormsOphthalmic ointment, 1% (10 mg/g), 3.5 g ophthalmic tip applicator tube
Mechanism of ActionAnticholinergic that blocks the response of the iris sphincter and of the ciliary body accommodative muscle to cholinergic stimulation. The result is pupillary dilation and paralysis of accommodation.
Warnings & Precautions
- Angle closure induction: Estimate the depth of the anterior chamber angle before use.
- Systemic poisoning: Excessive use in children, or in certain individuals with a previous history of susceptibility to belladonna alkaloids, may produce systemic atropine poisoning; discontinue and treat.
- Nasolacrimal occlusion: Compress the lacrimal sac with digital pressure for two to three minutes after instillation to limit systemic absorption.
Common Side Effects
- Ocular, prolonged use: Local irritation with follicular conjunctivitis, vascular congestion, edema, exudate, and eczematoid dermatitis.
- Systemic, severe: Hypotension with progressive respiratory depression; coma and death have been reported in the very young.
- Systemic, overdose: Flushing and dry skin (rash in children), blurred vision, rapid irregular pulse, fever, abdominal distension in infants, hallucinosis, loss of neuromuscular coordination.
- Frequency: No rates are given on this label.
Pregnancy & LactationPregnancy: No animal reproduction studies have been performed; whether fetal harm or an effect on reproductive capacity can occur is unknown, so use only if clearly needed.
Lactation: Not addressed on this label.
Pediatric UseExtreme caution in children and infants; coma and death have been reported in the very young.