6183 Behavioural side effects of atropine eye drops

Objectives Atropine sulfate eye drops are used to induce cycloplegia and mydriasis and therefore used in ocular penalisation as an alternative treatment to occlusion to treat amblyopia.¹ Service development in a North-West England community eye service saw the introduction of atropine penalisation as an available alternative to occlusion. Following this, paediatric orthoptic clinicians noted a trend in parental reports of behaviour changes as side effects of the treatment. A search of the literature found minimal reported evidence of behavioural side effects from the use of Atropine eye drops,² ³ especially in optical penalisation. Although side effects from this treatment are reported, these generally concentrate on ocular irritations rather than systemic or behavioural.⁴ This purpose of this work was to collate behavioural side effects and explore trends in their incidence. Methods Clinical data was collated and reviewed for patients whose parents reported behavioural side effects from Atropine optical penalisation treatment. All side effects were documented in patient records and yellow card reports were made for central UK reporting, with parental consent. Batch numbers for all cases was recorded and compared. Results During the time period October 2022 to February 2023; a total of eight parents reported behavioural side effects in their children undertaking atropine penalisation treatment, at a single community orthoptic site. A common factor was found in that many had used the same batch of Atropine eye drops. Side effects included eye rolling, irritability, hyperactivity and aggressive behaviour. In some cases, a joint clinician/parental decision was made to stop the atropine treatment as a result of these side effects. Conclusion Behavioural change is a viable side effect that should be considered with Atropine eye drop use in children. This pattern of incidents highlighted the importance of appropriate ocular instillation with punctal occlusion to prevent systemic absorption within clinical practise. It also raises awareness of the possibility of behavioural side effects caused by Atropine eye drops in children and potentially a defective batch of Atropine. As a result of these findings, local patient information leaflets were updated to improve information regarding correct installation of eye drops and risk of side effects. References Pediatric Eye Disease Investigator Group. A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors. 2003;110:1632–8. Polling JR, Tan E, Driessen S, Loudon SE, Wong H-L, van der Schans A, Tideman JWL, Klaver CCW. A 3-Year follow up study of atropine treatment for progressive myopia in Europeans. 2020;34:2020–2028. Princelle A, Hue V, Pruvost, Potey C, Dubos F, Martinot A. Systemic adverse effects of topical ocular instillation of atropine in two children. Arch pediatr. 2013;20(4):391–4. doi: 10.1016/j.arcped.2013.01.012. The Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol.2002;120(3):268–278. doi:10.1001/archopht.120.3.268.