Concerns About Atropine Use in Children for Eye Treatment

Q: Concerns About Atropine Use in Children for Eye Treatment

I recommend that you： 1. Discuss the above situation further with your attending physician. 2. Consider consulting an ophthalmologist at a major hospital. Wishing you good health. Thank you!

Pediatric Mydriatic Agent Issues

Hello Dr.
Liang,
I have a 13-year-old child in the first year of junior high school.
During a school vision screening, the left eye was measured at 0.6 and the right eye at 1.5.
We went for a follow-up examination at an ophthalmologist, where the left eye was measured at 0.8 and the right eye at 1.0.
The doctor indicated that the left eye has a refractive error of -1.00 diopters, while the right eye is normal.
They prescribed diluted Atropine to be administered in the left eye before bedtime.
My child has been using it for 5 days but is experiencing blurred vision both up close and at a distance, and there hasn't been any improvement in distance vision despite the use of the dilating drops.
Currently, there are fine blood vessels in the eyes, and while there is some light sensitivity, it is manageable.
The use of the drops in just one eye seems to be causing some dizziness for my child.

I would like to ask, Dr.
Liang, is it okay for my child to stop using the eye drops? Should we seek a second opinion from another ophthalmologist to confirm the vision? The hospital examination did not include a refraction test after dilation; it was only a standard visual acuity check.
Additionally, if we consider using orthokeratology lenses for correction, when would be the appropriate time to start this treatment? Thank you.

chun, 10~19 year old female. Ask Date: 2024/03/05

Dr. Liang Ce reply Ophthalmology

I recommend that you: 1.
Discuss the above situation further with your attending physician.
2.
Consider consulting an ophthalmologist at a major hospital.
Wishing you good health.
Thank you!

Reply Date: 2024/03/05

More Info

Atropine eye drops have been widely used in pediatric ophthalmology, particularly for the management of myopia (nearsightedness) and other refractive errors. However, concerns regarding their use in children, especially regarding side effects and the potential for rebound effects upon discontinuation, are valid and warrant careful consideration.

Side Effects of Atropine
Atropine is an anticholinergic agent that works by paralyzing the ciliary muscle of the eye, leading to dilation of the pupil (mydriasis) and paralysis of accommodation (the ability to focus on near objects). Common side effects include:
1. Blurred Vision: Due to the paralysis of the ciliary muscle, children may experience difficulty focusing on near objects, leading to blurred vision when reading or doing close work.

2. Photophobia: The dilation of the pupil can cause increased sensitivity to light, making bright environments uncomfortable.

3. Increased Intraocular Pressure: In rare cases, some individuals may experience elevated intraocular pressure, which can be particularly concerning for those with a predisposition to glaucoma.

4. Systemic Effects: Although rare, atropine can cause systemic anticholinergic effects such as dry mouth, flushing, and increased heart rate, particularly if absorbed in significant amounts.

Concerns About Discontinuation
Regarding the concern about stopping atropine treatment, it is essential to understand that while some anecdotal reports suggest a "rebound" effect—where myopia may worsen after discontinuation—this is not universally accepted in the medical community. The degree of rebound, if it occurs, can vary significantly among individuals. It is crucial to consult with an ophthalmologist before making any changes to the treatment plan. If the child is experiencing significant discomfort or side effects, such as blurred vision or photophobia, it may be reasonable to discuss the possibility of discontinuing the drops with the prescribing physician.

Monitoring and Follow-Up
Given that your child has been using atropine for only five days and is experiencing side effects, it would be prudent to schedule a follow-up appointment with an ophthalmologist. This visit can provide an opportunity to reassess the child's vision and overall eye health, as well as to discuss the appropriateness of continuing atropine therapy. The ophthalmologist may perform a comprehensive eye examination, including a refraction test under dilation, to determine the current refractive status accurately.

Alternative Treatments
If atropine is deemed unsuitable, or if the side effects are intolerable, other options may be considered. One such alternative is the use of orthokeratology lenses (corneal reshaping contact lenses), which can be effective in controlling myopia progression. The timing for starting orthokeratology treatment can vary; however, it is often recommended to begin as soon as myopia is diagnosed, especially in children who are at risk of rapid progression.

Conclusion
In summary, while atropine eye drops can be effective for managing myopia in children, they are not without potential side effects. If your child is experiencing discomfort or if there are concerns about the treatment's efficacy, it is essential to consult with an ophthalmologist for a thorough evaluation and to discuss alternative treatment options. Regular follow-up is crucial to ensure that the chosen treatment plan is effective and well-tolerated.

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