glasses and white bottle of eye drops | newdrugloft.com

Compounded Low-Dose Atropine Eye Drops

June 17, 2025

Myopia is the world’s most common eye disorder and is estimated to affect several billion people around the globe.^1,2 It can affect any age group but is more common in certain patient populations. Children, for instance, often experience rapid progression. There are several treatment options available for myopia, including corrective treatments like contact lenses and refractive surgeries such as LASIK. Other therapies are available to help slow its progression; they are mainly used in children and adolescents and include low-dose atropine.

Atropine Eye Drops for Myopia Control in Children

Atropine eye drops have been studied as an off-label treatment to slow progressive myopia in children. 1% atropine was first shown decades ago to markedly reduce myopia progression, but a more recent trial demonstrated that low-dose atropine (0.01%) slowed myopia progression with fewer side effects (such as pupil dilation and blurred near vision) compared to the 1% formulation.³

Reviews have shown that nightly low-dose atropine significantly reduces axial elongation in children. Despite this finding, it’s important to note that atropine does not correct myopia and only slows its progression, so children on atropine will still need to wear contact lenses or eyeglasses to see correctly.⁴ Fortunately, studies have shown that atropine works well as an adjunctive therapy with ortho-k lenses to slow axial elongation in children with myopia.⁵

Uveitis

Atropine drops can also be used to manage anterior uveitis (iritis) by dilating the pupil and paralyzing the ciliary body to help relieve painful ciliary muscle spasms and prevent iris adhesions that may occur with uveitis. Clinical guidelines from the American Optometric Association list atropine in concentrations as low as 0.5% for treating acute anterior uveitis to reduce pain and photophobia.

Veterinary Ophthalmological Indications for Atropine Eye Drops

Atropine eye drops are also used in veterinary ophthalmology to dilate pupils and manage eye pain in animals, such as treating equine uveiti.⁶ In pets and livestock, ophthalmic atropine solution is used off-label in much the same way as in humans to achieve mydriasis for retinal exams. It can also be used to treat ocular pain from uveitis or corneal injuries by relieving ciliary muscle spasms, or to treat pain associated with deep corneal ulcers that cause secondary iris spasms.

Are you a prescriber looking for compounded medical solutions?

Please complete our new account form.

Get Started ›

Because there’s no FDA-approved veterinary atropine product, veterinarians use human atropine formulations off-label. Animals may exhibit systemic side effects, such as drooling in cats due to the bitter taste draining into their throat or gastrointestinal stasis in horses due to long-term use.⁶ To mitigate these side effects, low-dose atropine (0.1%) was shown to be better tolerated than the 1% formulation in cats, who experienced shorter and less severe adverse effects such as drooling.⁷

Compounded Atropine Eye Drops

The 1% atropine formulation that is commercially available is generally not necessary or suitable for treating pediatric or veterinary patients. However, there are currently no commercially available low-concentration atropine eye drops, so a compounding pharmacy is needed to prepare a custom atropine formulation tailored to the specific needs of individual patients.

The only commercially available concentration of atropine ophthalmic solution is 1%, but treatments often demand much lower doses, especially for pediatric patients. For instance, low-dose atropine (e.g., 0.05%, 0.025%, and 0.01%) for myopia control must be prepared by a compounding pharmacy.^8,9 This allows prescribers to titrate the dose for optimal effect while minimizing side effects.

Preservative-Free & Hypoallergenic Preparations

Standard atropine solutions (especially multi-dose bottles) typically contain preservatives such as benzalkonium chloride (BAK) or chlorobutanol¹⁰, but these are potential irritants and allergens. Chronic exposure to BAK can induce ocular surface inflammation, dryness, and even allergic conjunctivitis in susceptible patients.

If a patient has a known sensitivity or allergy to a drop’s preservative or other excipients, a compounding pharmacy can prepare atropine eye drops that are preservative-free or that use an alternative, less-irritating preservative. For example, cases of children developing red, irritated eyes on commercial or compounded low-dose atropine with BAK have been reported, so switching to a preservative-free compounded atropine formulation resolved the reaction.

Why Choose VLS Pharmacy & New Drug Loft?

Compounded atropine eye drops are often required to meet patient-specific needs, such as providing lower strengths than what is commercially available or eliminating irritating or allergenic ingredients. With a valid patient-specific prescription, we can prepare atropine in concentrations from 0.01% to 0.5% and formulate it without irritating preservatives or excipients if necessary.

By working closely with a 503A compounding pharmacy, eye care providers can ensure that atropine therapy is precisely tailored to the specific needs of individual patients. Our atropine ophthalmic solutions are compounded in a sterile compounding facility that is USP chapters <795>, <797>, and <800> compliant.

Please comment below with any thoughts or questions.

Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

References

Myopia is responsible for around one-third of global uncorrectable visual impairment | Myopia Profile. Accessed June 16, 2025. https://www.myopiaprofile.com/articles/myopia-is-responsible-for-around-one-third-of-global-uncorrectable-visual-impairment
Myopia – Myopia Institute. September 23, 2020. Accessed June 16, 2025. https://myopiainstitute.org/myopia/
Wang Z, Li T, Zuo X, et al. 0.01% Atropine Eye Drops in Children With Myopia and Intermittent Exotropia: The AMIXT Randomized Clinical Trial. JAMA Ophthalmol. 2024;142(8):722-730. doi:10.1001/jamaophthalmol.2024.2295
Gifford KL, Richdale K, Kang P, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203. doi:10.1167/iovs.18-25977
Chen Z, Huang S, Zhou J, Xiaomei Q, Zhou X, Xue F. Adjunctive effect of orthokeratology and low dose atropine on axial elongation in fast-progressing myopic children—A preliminary retrospective study. Contact Lens Anterior Eye. 2019;42(4):439-442. doi:10.1016/j.clae.2018.10.026
Ström L, Dalin F, Domberg M, et al. Topical ophthalmic atropine in horses, pharmacokinetics and effect on intestinal motility. BMC Vet Res. 2021;17(1):149. doi:10.1186/s12917-021-02847-4
Handel KW, Ofri R, Goncharov Y, Arad D, Sebbag L. Evaluation of 0.1% and 1% atropine eyedrops in cats: A comparative study of tolerance, stability, and efficacy. Vet Ophthalmol. n/a(n/a). doi:10.1111/vop.13268
Yam JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124. doi:10.1016/j.ophtha.2018.05.029
Loughman J, Lingham G, Nkansah EK, Kobia-Acquah E, Flitcroft DI. Efficacy and Safety of Different Atropine Regimens for the Treatment of Myopia in Children: Three-Year Results of the MOSAIC Randomized Clinical Trial. JAMA Ophthalmol. 2025;143(2):134-144. doi:10.1001/jamaophthalmol.2024.5703
Atropine. React Wkly. 2018;1729(1):40-40. doi:10.1007/s40278-018-54670-7