Atropine in Amblopia

It is fairly common still to for OD’s and MD’s to use atropine penalization for amblyopia treatment, and that this can continue for up to a year or more. Still, there is very little data supporting this practice over other methods, such as repeated short term patching with active therapy.

In the case of atropine use, there are very real dangers, including histologic changes that occur, and likely functional changes including a ‘presbyopic syndrome’ where the accommodative force and range is reduced even in the very young. The major concern is that the research is lacking on the negative effects of the practice and is focused largely on acuity outcomes.

Here’s one of a few studies that looked at functional anatomical changes in the ciliary body following treatment with atropine. The message is: Proceed with caution when considering long term mydriasis, and look to other methods first.


Age-related changes in human ciliary muscle.


School of Optometry, University of Waterloo, Canada.



To examine the role of the ciliary muscle in accommodation and presbyopia.


Sixteen pairs of eyes from donors aged 1 to 107 years were treated with atropine or pilocarpine and then processed for light microscopy. Seven pairs were analyzed for treatment effects, including morphometric measurements of muscle dimensions, muscle fiber group area, and the percentage of connective tissue.


The ciliary muscle shortened in length in response to drug treatment at all ages. The ciliary muscle of older subjects contained greater amounts of connective tissue and was shorter, wider and the internal apical edge moved forward.


This study confirms previous reports that the human ciliary muscle retains its ability to contract throughout the lifespan. However, the ciliary muscle also displayed age-related changes, which may be partly accounted for by the forces exerted from the aging lens and zonules.


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