Occlusion therapy, atropine eye drops

What is occlusion therapy?

Occlusion (using an eye patch or atropine eye drops) is a method of treatment used to improve ‘amblyopia’ in children.

What is amblyopia?

Amylyopia is poor vision in one eye, which is not due to a disease of the eye. It occurs when normal visual development is prevented or disrupted in childhood. It is usually due to:

• a squint – when one eye appears straight and the other turns in, out, up or down
• the need for glasses – where one lens is stronger than the other

Ideally treatment should be well under way before the age of 7 years (before the vision has stopped developing).

Will it get better on its own?

No. If left untreated a child may have permanently impaired sight in the ‘lazy’ eye which cannot be treated when they are older.

How does the atropine eye drop work?

Atropine is an eye drop which is used to blur the vision in the good eye when viewing close objects and to promote the vision in the weaker eye.

Does my child need to wear their glasses at the same time?

Yes. If your child has glasses it is vital that the atropine and the glasses are used together.

How long will my child need to use atropine drops?

This will depend on several factors such as the level of vision in each eye and the age of your child. It is not possible to predict at the start of treatment how long it will last for.

If their vision does not improve after a reasonable period of putting in the atropine drops properly, then you may be advised to try patching treatment or to stop treatment.

How do I get the atropine?

You will receive your first supply of atropine from the hospital. After this please contact your GP who will be able to provide a prescription for you to collect the drops from any pharmacy.

What effects do the eye drops have?

Blurred vision

The dilating drops affect a child’s ability to focus causing blurred near vision which may last up to 7 days or more.

Dilated pupil

The pupil of the eye you are putting drops in will become ‘dilated’, meaning large, and non-reactive. If treatment is stopped the pupil may remain large for between 7 and 14 days depending on eye colour.

Sensitivity to light

The dilating drops prevent the pupil from controlling the amount of light entering the eye. We recommend sunglasses or a cap in the summer.

Swapping squint

If your child has a squint (turn in the eye), you may notice that the squint swaps into the other eye when focusing on something close to them. This is one of the aims of the treatment. However, if the squint swaps into the other eye all of the time, please contact the Eye Department and arrange a sooner appointment.

Appointments

Your child will need to be reviewed regularly while they are under treatment.

If you change your appointment or are unable to attend when planned, please let a clinician know that your child is using this treatment. If your appointment is significantly delayed you may have to temporarily stop treatment until you can re-attend regularly.

How often should I put in the eye drops to the good eye?

The instruction regime will be given to you by your orthoptist. This could be twice weekly or more. The drops can even be put in whilst your child is asleep. It is important to put in an eye drop at your scheduled time even if the pupil may still be dilated from the day before.

How long do the effects of the atropine last?

Atropine will cause blurred vision, which may last up to 7 days or more after using it. The pupil may also remain dilated for up to 14 days.

Are there any side effects I should look out for?

Do not use atropine if your child is allergic to any of the ingredients or if they experience significant side effects. Please read the leaflet which accompanies the eye drops.

It will make the dilated eye sensitive to light, so avoid bright light. Wearing a sun hat may help.

Your child may feel a little discomfort when initially instilled.

Tell your ophthalmologist or orthoptist if your child is taking any other medication.

How can I help prepare my child for having eye drops?

It is vitally important that you adopt a positive approach in preparing your child for eye drops. If you are negative in any way, you can affect your child’s co-operation.

How should I put in the atropine?

There are two methods you may use:

1. Closed eye method
2. Open eye method

The closed eye method for atropine drops

1. Wash your hands thoroughly, peel the over-wrap apart and take out the drops.
2. Twist off the cap.
3. Tilt your child’s head back or lay them flat on their back, with their eyes closed.
4. Avoid touching the dropper against your child’s eyelids or eyelashes.
5. Gently squeeze until a drop of liquid falls onto the corner of the closed eye nearest the nose.
6. Do not ask the child to open their eyes.
7. Ask your child to keep their eyes closed until the eyelashes are wet, then dab off the excess liquid with a tissue, but do not completely dry the lashes.
8. Your child can then open their eyes and blink 3 times you may then dry their lashes completely.
9. Always wash your hands and your child’s hands after using the drops to avoid it being taken internally.
10. Repeat the procedure at approximately the same time each day.
11. Continue putting the eye drops in once daily until and including the day of your next appointment.

The open eye method for atropine drops

1. Wash your hands thoroughly, peel the over-wrap apart and take out the drops.
2. Twist off the cap.
3. Get your child into any of these positions to give the eye drops:
   1. Tilt your child’s head back
   2. Lay your child flat on their back
   3. Ask someone to hold your child in a safe and comfortable position
   4. Wrap your baby or young child in a light blanket or sheet to keep their arms and legs still if you are on your own
4. Gently pull down the lower eyelid of one of the eyes with your finger, ask your child to look upwards.
   
5. Avoid touching the dropper against your child’s eye, eyelashes or any other surface.
6. Gently squeeze until a drop of liquid falls into the gap between the eyeball and lower eyelid.
7. Gently press on the inner corner of the eye for 30 seconds, this will help to stop the solution draining away into the nose and throat.
   
8. Always wash your hands and your child’s hands after using the drops to avoid it being swallowed or inhaled.
9. Repeat the procedure at approximately the same time.
10. Continue putting in the eye drops as your schedule describes up until the day of your next appointment.