Atropine (EENT)
Drug class: Antineoplastic Agents
Usage of Atropine (EENT)
Ophthalmologic Examination
Used to produce mydriasis and cycloplegia for refraction (e.g., retina and optic disc examination, measurement of refractive error). However, because of long duration of action relative to that of other anticholinergic agents, atropine is seldom, if ever, used for cycloplegic refraction in adults.
In rare cases, ophthalmic atropine use may be necessary to achieve maximal cycloplegia in pediatric patients, but cyclopentolate is more frequently used.
Ophthalmic Inflammation
Management of acute inflammatory conditions (e.g., iridocyclitis) of the iris and uveal tract (e.g., uveitis).
Amblyopia
Used for cycloplegic effects in the treatment of suppression amblyopia (lazy eye) to reduce the visual acuity of the unaffected eye below that of the amblyopic one and force fixation with the amblyopic eye.
Excess Accommodation and Convergence
Used to treat patients with a functional excess of accommodation and convergence.
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How to use Atropine (EENT)
General
Administration
Ophthalmic Administration
Apply topically to eye(s) as an ophthalmic ointment or solution.
For topical ophthalmic use only. Not for injection.
Following topical application, apply finger pressure on the lacrimal sac for 2–3 minutes to avoid excessive systemic absorption.
Avoid contamination of the solution or ointment container.
Dosage
Available as atropine sulfate; dosage expressed in terms of the salt.
In patients with heavily pigmented irides, higher dosages may be required.
Pediatric Patients
Cycloplegic Refraction† [off-label] Ophthalmic1–2 drops of a 0.5% solution in the eye(s) twice daily has been used for 1–3 days before the procedure, but this preparation no longer is commercially available in the US. No specific pediatric dosage recommendations for 1% ophthalmic solution. (See Pediatric Use under Cautions.)
Alternatively, apply 0.3 cm of a 1% ointment into the conjunctival sac 3 times daily for 1–3 days before the procedure. (See Pediatric Use under Cautions.)
Inflammatory Conditions Uveitis† [off-label] Ophthalmic1–2 drops of a 0.5% solution into the affected eye(s) up to 3 times daily has been used, but this preparation no longer is commercially available in the US. No specific pediatric dosage recommendations for 1% ophthalmic solution.
Alternatively, apply 0.3–0.5 cm of a 1% ointment into the conjunctival sac of the affected eye(s) 1–3 times daily.
Adults
Mydriasis and Cycloplegia for Refraction Ophthalmic1 drop of a 1% solution in the eye(s) 1 hour before the procedure.
Alternatively, apply 0.3–0.5 cm of a 1% ointment into the conjunctival sac 1–3 times daily. If ointment is used for refraction, apply several hours before procedure.
Inflammatory Conditions Uveitis Ophthalmic1–2 drops of a 1% solution into the affected eye(s) up to 4 times daily, or as directed by a clinician. Alternatively, apply 0.3–0.5 cm of a 1% ointment into the conjunctival sac of the affected eye(s) 1–3 times daily.
Special Populations
No special population dosage recommendations at this time.
Warnings
Contraindications
Warnings/Precautions
Warnings
OverdosageExcessive use in children and patients with a history of susceptibility to belladonna alkaloids may produce systemic manifestations of atropine poisoning (e.g., flushing, skin dryness, rash in children, rapid and irregular pulse, fever, abdominal distention in infants, mental aberration, loss of neuromuscular coordination). If systemic symptoms occur, discontinue the drug and initiate appropriate therapy.
Specific Populations
PregnancyCategory C.
LactationNot known whether atropine is distributed into milk. Caution when used in nursing women.
Pediatric UseSafety and efficacy of atropine sulfate 1% ophthalmic solution have not been established in pediatric patients.
Use with extreme caution, if at all, in infants and small children, and in children with spastic paralysis or brain damage because of increased susceptibility to the systemic effects of the drug in these patients.
Coma and death have been reported in very young patients.
Geriatric UseNo substantial differences in safety or efficacy relative to younger adults.
Common Adverse Effects
Elevated IOP. With prolonged administration, local irritation, hyperemia, edema, exudate, follicular conjunctivitis, dermatitis.
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