Atropine Penalisation

How does atropine penalisation work and when is it used instead of patching?

Video Transcript:

As an alternative to patching the stronger eye can be “penalized” by using atropine drops once a day to this eye. These drops weaken the focusing mechanism of the eye so reducing the close up vision to such an extent that the child’s brain “chooses” the image form the amblyopic eye rather than the blurred image from the stronger eye.

Penalisation of the better seeing eye with atropine drops or ointment has been demonstrated to be as effective as patching for moderate amblyopia (20/40 to 20/100; 6/12 to 6/30). It has also been used to successfully treat severe amblyopia.

Although the initial improvement in vision appears to be more rapid with patching, the visual improvement after six months of treatment is equally good.

Why isn’t atropine penalisation the first choice of treatment for amblyopia?
While atropine is as effective as patching for treating amblyopia, and may be a more acceptable form of treatment to some children and their parents, it is less controllable than patching, as the effects of the atropine last for up to 2 weeks and can, rarely, cause a drop in vision in the good eye. This is known as reversal amblyopia and is the reason why a child having atropine penalisation needs to be seen every 2-3 weeks, so the vision in both eyes can be closely monitored. The risk of reversal amblyopia and the increased number of clinic visits are the main reasons why atropine penalisation is not routinely used as the initial treatment for amblyopia by most Ophthalmologists.

Atropine penalisation tends to be used if patching treatment has been unsuccessful despite good compliance with patching, or of the child is unable to tolerate wearing a patch.