Treating amblyopia (‘lazy eye’) with atropine drops

This page from Great Ormond Street Hospital (GOSH) explains how amblyopia – commonly known as ‘lazy eye’ – can be treated with atropine drops. This is a form of ‘occlusion’ and is an alternative to patching. It explains how to use the drops, side effects to watch out for and what to do if they occur.Occlusion is advised when the vision in one eye is reduced due to amblyopia (lazy eye). The ‘good’ eye may be occluded with a patch or atropine drops. Occluding the good eye ‘forces’ the lazy eye to work harder and over time can improve the vision.

Atropine is a medication that makes it difficult for the eye to focus for close distances and makes the black part of the eye (pupil) large. At GOSH, we use 1 per cent atropine, which come in ‘minims’ – single dose squeeze containers.

Following the dosage instructions provided,

1. Always wash your hands and your child’s hands before and after using the drops.
2. Twist off the top off the minim – use a new one for each dose
3. Gently pull down your child’s lower eyelid with your finger
4. Avoid touching the container against your child’s eye, eyelashes or any other surface
5. Put one drop of atropine into the lower eyelid avoiding the corner of the eye and then release the eyelid
6. Gently press on the inner corner of the eye for up to one minute. This helps to prevent the drop draining into the nose and being swallowed.
7. Dispose of the used minim in your household rubbish

We will review your child again in a few weeks as stated above. If you cannot attend this appointment, tell us as soon as possible so we can offer it to another child.

Do not continue using the atropine eye drops if you do not have a follow up appointment. The treatment must be carried out under strict supervision.

Yes. It is important that your child continues to wear their glasses to give the weaker eye the best chance to improve.

Do not use atropine if your child suffers from heart problems or has a high fever.

As with most medicines some side effects may occur. Your child may be more sensitive to light than usual due to the larger pupil letting more light into the eye. It may help to wear a broad-brimmed hat or sunglasses in very sunny weather.

Please read the patient information leaflet (PIL) included in the package before starting the treatment. There are reported side effects which are rare. These include:

• Itchy or swollen eyelids
• Red or watery eyes
• Dryness of skin/mouth
• Fever
• Flushing of face
• Restlessness
• Hyperactivity
• Irritability
• Vomiting

If your child experiences any side effects, stop using the drops and seek medical advice immediately.

• Store the eye drop minims in a dry place at room temperature away from direct sunlight
• Store medicines in a safe place where children cannot reach them – atropine can be poisonous if swallowed.
• The atropine has been prescribed for your child and should not be given to any other person.

Always check the expiry date before giving the drops to your child. If it has passed its expiry date, do not use the drops and telephone the Ophthalmology department.

Use a fresh minim for every dose – throw the used minim away in your household rubbish after use.

Inform your child’s school about the use of the drops and the dilated pupil.

Please ensure that any doctor or dentist treating your child is aware that atropine is being used.

Do not continue using atropine if you have missed an appointment - your child should only use the drops under medical supervision.