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Atropine ophthalmic Side Effects

For the Consumer

Applies to atropine ophthalmic: ophthalmic ointment, ophthalmic solution

Side effects include:

Elevated IOP. With prolonged administration, local irritation, hyperemia, edema, exudate, follicular conjunctivitis, dermatitis.

For Healthcare Professionals

Applies to atropine ophthalmic: ophthalmic ointment, ophthalmic solution


Atropine toxicity (anticholinergic side effects) may occur after ocular administration and often presents as fever, agitation, and dry skin/mucous membranes.[Ref]


Cardiovascular side effects have included flushing, hypotension, tachycardia, arrhythmias, atrial fibrillation, supraventricular tachycardia, coma, and death after ocular atropine.[Ref]

Nervous system

If delirium due to atropine develops and there are no contraindications, many experts recommend the use of 2 mg of physostigmine IM or IV once or twice (as needed) as an effective antidote. Repeated doses may be necessary. Diazepam has been useful for the treatment of convulsions secondary to atropine poisoning.[Ref]

Nervous system side effects have included lethargy and somnolence. Systemic atropine toxicity may result in hallucinosis, loss of neuromuscular coordination, seizures, and agitation. The elderly and very young appear to be more prone to the anticholinergic effects of atropine on the CNS.[Ref]


Ocular side effects have included inhibition of the iris sphincter muscle (resulting in mydriasis), blurry vision, inhibition of the ciliary muscle (which can interfere with near vision in up to 23% of patients), increased intraocular pressure and precipitation of acute narrow angle glaucoma. Prolonged use may result in local irritation (follicular conjunctivitis, vascular congestion, edema, exudate, and eczematoid dermatitis),[Ref]


Gastrointestinal side effects have included abdominal distention (in infants), decreased gastrointestinal motility, and salivation.[Ref]


Hypersensitivity reactions have rarely included systemic reactions, manifested by urticaria, eczema, papillary hyperplasia, mucopurulent discharge, eosinophilia, pruritus, edema, hypotension, abdominal pain, tachypnea, nausea and vomiting. Contact dermatitis has rarely been associated with atropine ophthalmic preparations.[Ref]


Respiratory side effects associated with severe reactions have included progressive respiratory depression.[Ref]


Dermatologic side effects have included rash (a possible sign of atropine toxicity).[Ref]


1. "Product Information. Atropisol (atropine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.

2. Sanitato JJ, Burke MJ "Atropine toxicity in identical twins." Ann Ophthalmol 15 (1983): 380-2

3. Gillick JS "Atropine toxicity in a neonate." Br J Anaesth 46 (1974): 793-4

4. Merli GJ, Weitz H, Martin JH, et al "Cardiac dysrhythmias associated with ophthalmic atropine." Arch Intern Med 146 (1986): 45-7

5. Purcell MJ "Atropine poisoning in infancy." Br Med J 5489 (1966): 738

6. German E, Siddiqui N "Atropine toxicity from eyedrops." N Engl J Med 282 (1970): 689

7. Joseph VJ, Rekha S, Subba Rao SD, Chandrasekhara MK "An unusual case of atropine toxicity." Indian Pediatr 28 (1991): 943-4

8. van der Willigen AH, de Graaf YP, van Joost T "Periocular dermatitis from atropine." Contact Dermatitis 17 (1987): 56-7

9. Karliner W "Accidental convulsion induced by atropine." Am J Psychiatry 122 (1965): 578-9

10. Winslow RL "Atropine pupils." JAMA 229 (1974): 1863-4

11. Weinstock FJ "Dilated fixed pupils from atropine." JAMA 229 (1974): 267-8

12. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4

13. Meerstadt PW "Atropine poisoning in early infancy due to Eumydrin drops." Br Med J (Clin Res Ed) 285 (1982): 196-7

14. Kounis NG "Atropine eye-drops delirium." Can Med Assoc J 110 (1974): 759

15. Heiser JF, Gillin JC "The reversal of anticholinergic drug-induced delirium and coma with physostigmine." Am J Psychiatry 127 (1971): 1050-4

16. Joel SW "Atropine pupils." JAMA 229 (1974): 1863

17. Carney MW "Atropine poisoning." Br Med J 2 (1974): 334

18. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4

19. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880

20. Pecora JL "Atropine pupils." JAMA 229 (1974): 1864

21. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34

22. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4

23. Palmer EA "How safe are ocular drugs in pediatrics?" Ophthalmology 93 (1986): 1038-40

24. Pickford EJ, Hanson RM, O'Halloran MT, Fenwick D, Noble P, McDonald JD "Infants and atropine: a dangerous mixture." J Paediatr Child Health 27 (1991): 55-6

25. Lahdes K, Kaila T, Huupponen R, Salminen L, Iisalo E "Systemic absorption of topically applied ocular atropine." Clin Pharmacol Ther 44 (1988): 310-4

26. Yoshikawa K, Kawahara S "Contact allergy to atropine and other mydriatic agents." Contact Dermatitis 12 (1985): 56-7

Not all side effects for atropine ophthalmic may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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