Atropine eye drops (low-dose) are a compounded, prescription ophthalmic solution of atropine prepared at low concentrations. Low-dose atropine is used to help slow the progression of nearsightedness (myopia) in children. It is prepared by a licensed pharmacy to the strength your eye doctor orders rather than mass-produced, most commonly at 0.01%, 0.02%, or 0.05%.
Because there is no FDA-approved low-dose atropine product in the United States, eye doctors prescribe it off-label and rely on a compounding pharmacy to prepare these low concentrations. Only a licensed eye care provider can decide whether it is right for a child.
How does it work?
Myopia tends to progress as a child's eye grows too long from front to back, so distant objects focus in front of the retina instead of on it. Used as a nightly eye drop, low-dose atropine is thought to act on the eye to slow that excessive lengthening, which slows how quickly myopia progresses (American Academy of Ophthalmology). Evidence gathered over about two decades supports that low-dose atropine can slow myopia progression in many children (AAO Ophthalmic Technology Assessment). Your eye doctor sets the concentration and schedule.
What is it used for?
Low-dose atropine is prescribed to help slow the progression of myopia in children, typically one drop at bedtime over a period of years while the eyes are still growing. The American Academy of Ophthalmology notes that low-dose atropine can slow myopia progression, and in the LAMP study, among the low doses compared, 0.05% showed the greatest effect, while 0.01% had the fewest side effects; the right concentration depends on the individual child (LAMP study). It is used off-label because there is no FDA-approved low-dose atropine product in the United States. Only a licensed eye care provider can decide whether it is appropriate; Bayview Pharmacy does not provide consultations or determine appropriateness, and a valid prescription is required.
How do the strengths compare?
Low-dose atropine is compounded at a few low concentrations that differ mainly in how strong they are. In general, higher concentrations within this low range may slow progression somewhat more but can cause a little more light sensitivity and near blur, while the lowest concentration has the fewest side effects. The table below describes those differences for education only.
| Strength | Notes |
|---|---|
| 0.01% | The most studied low dose; generally the fewest side effects and the least rebound when stopped |
| 0.02% | An intermediate low concentration |
| 0.05% | Among the low doses in the LAMP study, showed the greatest effect; may cause slightly more light sensitivity or near blur |
| Custom | Other concentrations as your eye doctor orders |
Strengths are described for education only and are not a statement that any concentration is better for a particular child. Your eye doctor selects the concentration and schedule that are appropriate.
How is it used?
Use it exactly as your eye doctor directs, which is usually one drop in each eye once daily at bedtime. Wash your hands before and after, and do not let the dropper tip touch the eye or any surface. For a child, an adult should give the drops. Using the drop at bedtime helps reduce daytime light sensitivity and blurred near vision. If more than one eye drop is prescribed, wait about five minutes between them. Do not stop or change the schedule on your own, because stopping suddenly can allow faster progression again (rebound); follow your eye doctor's plan. A Bayview pharmacist is available if you have questions about your prescription.
Side effects & safety
Low-dose atropine is generally well tolerated. The most common effects are mild and related to the concentration, such as light sensitivity (from slightly larger pupils), blurred near vision, and eye redness or itching; these are less common at the lowest concentrations, and using the drop at bedtime helps limit daytime symptoms. Rarely, atropine can cause body-wide (anticholinergic) effects such as facial flushing, dry mouth, fast heartbeat, or fever, which are uncommon at low ophthalmic doses; seek care if these occur.
Contact your eye doctor about eye redness that does not go away, eye pain, or any vision change that concerns you.
Who should not use it?
Atropine is not appropriate for everyone. It should not be used by anyone with a known allergy to atropine or related belladonna alkaloids, or with certain eye conditions such as untreated narrow-angle glaucoma, unless a provider specifically directs otherwise. Tell your eye doctor about the full health history, allergies, and all medications of the person who will use it, so they can determine whether low-dose atropine is appropriate.
How should it be stored?
Store exactly as directed on your label, away from heat and light; some compounded atropine drops are kept refrigerated, so follow your label. Keep the bottle tightly closed and out of the reach of children, and do not share it. To avoid contamination, do not touch the dropper tip to the eye or any surface. Do not use it after its beyond-use date, and dispose of unused medication as directed.
Why is this compounded?
Only 1% atropine is commercially available in the United States, and there is no FDA-approved low-dose atropine product for myopia. Compounding lets a licensed pharmacy prepare atropine at the low concentrations used for myopia control, for example 0.01%, 0.02%, or 0.05%, to your eye doctor's exact prescription. As a 503A compounding pharmacy, Bayview Pharmacy prepares each order as a sterile ophthalmic preparation in small batches under USP <797> standards using quality ingredients. Compounded preparations are not FDA-approved.
Clinical details for prescribers
Regulatory status. Atropine is not a controlled substance. There is no FDA-approved low-dose atropine product for myopia in the United States; only 1% atropine is commercially available (approved for cycloplegia, mydriasis, and as an adjunct for amblyopia/uveitis). Low-dose atropine for myopia is prescribed off-label and requires compounding. (Sydnexis SYD-101 received an FDA Complete Response Letter in 2025; a low-dose atropine was authorized in the EU in 2025.) Compounded preparations are not FDA-approved.
Formulation & SIG. Compounded sterile ophthalmic solution at 0.01%, 0.02%, and 0.05% (custom concentrations available), in 5 mL or 10 mL. Typical SIG: instill 1 drop into each eye (or as specified) once daily at bedtime. Prepared under USP <797> sterile-compounding standards.
Evidence & clinical points:
- AAO Ophthalmic Technology Assessment: Level I evidence supports atropine to slow myopic progression
- LAMP study: dose-related effect (0.05% > 0.025% > 0.01%); 0.05% greatest effect among low doses; 0.01% fewest side effects and least rebound
- Monitor with cycloplegic refraction and axial length; plan duration and tapering given rebound considerations
- Contraindicated with atropine/belladonna-alkaloid hypersensitivity; caution with narrow-angle glaucoma
Ordering: send a prescription to Bayview, or use our Atropine Ophthalmic order form (fax 401-284-4506). Background: AAO, Low-Dose Atropine for Kids with Myopia; LAMP study.
This is a prescription compounded medication and is not FDA-approved. This information is educational and is not medical advice. Your eye care provider determines whether it is appropriate and sets the concentration and dose.
