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Effectiveness of Part-Time Monocular 1% Atropine Therapy for Intermittent Exotropia Control in Young Children
TAKE-HOME MESSAGE
- This retrospective chart review reveals that, in a cohort of 28 patients aged 12 months to 8 years (mean age, 31 months) with intermittent exotropia, the application of 1% atropine in the dominant eye for 2 consecutive mornings per week for a minimum of 6 weeks resulted in an improvement in exotropia measured as well as control of deviation.
- This passive strategy appears to be safe, well-tolerated, and may be effective, particularly in cases where more active participation in treatment is required. The mechanism by which 1% atropine reduces exotropia has yet to be elucidated; further research is warranted.
abstract
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Vision Development and Rehabilitation
This is a very interesting study because it was apparently the first one that looked at the potential use of 1% atropine as a therapeutic tool to improve a child's control of intermittent exotropia (IXT). According to the authors' review, treatment outcomes for young children with IXT to date have been less than satisfactory when involving alternating occlusion, which is disruptive to fusion, and overminus lens therapy, which runs the risk of accelerating the progression of myopia. Although lens and/or prism therapy may be beneficial, the child must be of sufficient age, maturity, and cognitive capacity to be compliant with this approach.
Although 1% atropine treatment for amblyopia interferes with schoolwork, this is not a limitation when used with young children. As the authors concluded, it would, therefore, be desirable if 1% atropine therapy could provide an effective holding pattern, or even improve IXT control, to provide a bridge until more active therapy can be undertaken. The authors conceded that, although the results are intriguing, the therapeutic mechanism is not yet understood and that their study will have to be replicated with a larger number of patients and for longer periods of time. If replicated, this will be a groundbreaking study of yet another off-label application of atropine.