Cosmesis Reversibility Systemic side effects Compliance Binocularity

Obtrusive Often poor None

Easy to remove Impaired during treatment


Effects last for up to 2 weeks Rare but potentially dangerous Once instilled, compliance is assured Allowed

frequent in children with Down's syndrome. Side effects are rare and relate to systemic parasympathetic blockade. They include flushing, dry mouth, hyperactivity, tachycardia and rarely seizures. Side effects appear to be dose-related and so are more common in infants and smaller children. Atropine ointment has been used instead of drops, and pressure on the lacrimal sac after instillation has been recommended, in an attempt to reduce systemic absorption in the nose, but will not prevent systemic absorption through conjunctival vessels.

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