Japanese Journal of Ophthalmology

, Volume 62, Issue 5, pp 531–536 | Cite as

Incidence of side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in Japanese children: a multicenter study

  • Akemi WakayamaEmail author
  • Sachiko Nishina
  • Atsushi Miki
  • Takashi Utsumi
  • Jun Sugasawa
  • Takao Hayashi
  • Miho Sato
  • Akiko Kimura
  • Takashi Fujikado
Clinical Investigation



To investigate the incidence rate and side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in children aged 15 years or under.


This prospective study had been conducted at 9 institutions between April 1, 2016 and March 31, 2017 in patients 15 years old or younger who received either atropine or cyclopentolate for refraction assessment. The investigation included patient’s age, symptoms, and whether patients with side effects had any systemic diseases.


A total of 811 patients (mean age ± SD, 4.6 ± 2.2 years) received atropine and 71 (8.8%) patients had side effects. Except in patients under two years old, 1% eye drops showed higher incidence rate of side effects than 0.5% and 0.25% eye drops. Side effects most frequently occurred following the initiation of the instillation on the first day. The symptoms included flush (29/71, 40.8%), fever (21/71, 30.0%), and both (11/71, 15.5%). A total of 2238 patients (5.7 ± 3.0 years) used cyclopentolate and 27 (1.2%) (4.0 ± 2.2 years) patients had side effects. The symptoms included drowsiness (10/27, 37.0%), red eye (4/27, 14.8%), fever (3/27, 11.1%), and flush (3/27, 11.1%).


Atropine has a side effect incidence rate 7 times higher than the incidence rate of cyclopentolate. Flush and fever are the most common side effects of atropine and drowsiness is the main side effect of cyclopentolate. These findings should be noted when examining cycloplegic refraction to manage amblyopia and strabismus in children.


Side effect Accommodative cycloplegic eye drops Atropine sulfate Cyclopentolate hydrochloride Children 



The authors thank Reiyo Tahara for editorial support.

Conflicts of interest

A. Wakayama, None; S. Nishina, None; A. Miki, None; T. Utsumi, None; J. Sugasawa, None; T. Hayashi, None; M. Sato, None; A. Kimura, None; T. Fujikado, None.


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Copyright information

© Japanese Ophthalmological Society 2018

Authors and Affiliations

  • Akemi Wakayama
    • 1
    Email author
  • Sachiko Nishina
    • 2
  • Atsushi Miki
    • 3
  • Takashi Utsumi
    • 4
  • Jun Sugasawa
    • 5
  • Takao Hayashi
    • 6
  • Miho Sato
    • 7
  • Akiko Kimura
    • 8
  • Takashi Fujikado
    • 9
  1. 1.Department of OphthalmologyKindai University Faculty of MedicineOsakasayamaJapan
  2. 2.Division of OphthalmologyNational Center for Child Health and DevelopmentTokyoJapan
  3. 3.Department of OphthalmologyKawasaki Medical SchoolKurashikiJapan
  4. 4.Utsumi Eye ClinicIbaragiJapan
  5. 5.Department of OphthalmologyOsaka Medical CollegeTakatsukiJapan
  6. 6.Department of OphthalmologyTeikyo University School of MedicineTokyoJapan
  7. 7.Department of OphthalmologyHamamatsu UniversityHamamatsuJapan
  8. 8.Department of OphthalmologyHyogo College of MedicineNishinomiyaJapan
  9. 9.Department of OphthalmologyOsaka University Graduate School of MedicineSuitaJapan

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