Comparison of cycloplegic effects of atropine and tropicamide in children with refractive error

Refractive error is the primary cause of vision impairment in children and requires accurate cycloplegic refraction for proper diagnosis and treatment. Various cycloplegic agents are used clinically, but their comparative efficacy remains controversial, particularly across different pediatric age groups and refractive error types. The purpose of this study was to observe the cycloplegic effects of tropicamide and atropine in children of different ages and different refractive errors, and to screen out more suitable drugs for cycloplegia in children with different refractive errors.

This study is a prospective cohort study. In this study, 110 children with refractive error were first dilated with 4 g/L of tropicamide eye drops; after the pupils recovered, they were dilated with 8 g/L of atropine eye ointment, and the results of the two pupil dilation methods were compared.

In hyperopic eyes, the cycloplegic refraction obtained using the two methods was the same spherical correction in 8.45%; cylindrical correction differed by >0.25 D in 91.54%, 14.28% were the same, and 85.71% had a difference of ≥0.25 D. Compared with refraction using tropicamide, atropine refraction had a significantly higher mydriatic effect on spherical and cylindrical lenses in all age groups, and the difference was statistically significant (P<0.001). In the myopia group, among the spherical lenses, 13.04% of the eyes were the same, and 86.9% of the eyes had differences; among the cylindrical lenses, 20% of the eyes were the same, and 80% of the eyes had differences. The cycloplegic effect of 4 g/L of tropicamide eye drops on spherical and cylindrical lenses was less than that of 8 g/L of atropine eye ointment. In the mixed astigmatism group, among spherical lenses, 14 eyes had differences, accounting for 100.0% of cases, with the maximum difference being 1.25 D; among cylindrical lenses, 5 eyes had the same results between the two pupil dilation methods, accounting for 35.7% of cases, and 64.3% had a difference of 0.25-0.5 D.

In children under 12 years old with mixed astigmatism and hyperopia, cycloplegic refraction using atropine is preferred over tropicamide.