# Myopia (nearsightedness) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD69.02 - condition scope only, no dose · Myopia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK580529/ · No dose - referral pathway, no medicine given in primary care · Myopia - disease-level clinical article (myopia-full.txt) · Ryjunea 0.1 mg/ml eye drops, solution (atropine sulfate) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 102228, emc-ryjunea-atropine-0.01pct.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Myopia (nearsightedness) - disease-level clinical article (myopia-clinical.txt) - Myopia - disease-level clinical article (myopia-full.txt) - Ryjunea 0.1 mg/ml eye drops, solution (atropine sulfate) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 102228, emc-ryjunea-atropine-0.01pct.txt) ## Treatment metadata - Correct the refraction, then consider myopia control (Recognition & Referral) - Atropine — eye ## Complete treatment card ```text MYOPIA (NEARSIGHTEDNESS) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD69.02 - condition scope only, no dose · Myopia - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK580529/ · No dose - referral pathway, no medicine given in primary care · Myopia - disease-level clinical article (myopia-full.txt) · Ryjunea 0.1 mg/ml eye drops, solution (atropine sulfate) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 102228, emc-ryjunea-atropine-0.01pct.txt) Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Myopia (nearsightedness) - disease-level clinical article (myopia- clinical.txt), Myopia - disease-level clinical article (myopia- full.txt), Ryjunea 0.1 mg/ml eye drops, solution (atropine sulfate) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 102228, emc- ryjunea-atropine-0.01pct.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Painless blurred distance vision with usually preserved near vision is the core complaint - A child might squint, sit nearer the television, or ask for a front-row classroom seat - Adults may notice worsening night vision or glare sensitivity - Floaters or a sudden acuity change in severe myopia can signal a retinal tear or neovascularization [floaters] - Parents note the child holding books close to the face and being unable to watch TV beyond 3 feet - Astigmatism can cause asthenopia with headache, diurnal visual variation, and occasional double vision [double vision · headache] - Sudden floaters, flashes, or peripheral vision loss need urgent review to rule out a retinal tear [floaters] SIGNS - what you find (6) - Axial length over 26 mm signals severe myopia needing closer monitoring - Fundus exam in higher myopia may show peripapillary atrophy, tilted discs, and a tessellated look [atrophy] - Exotropia is common with moderate to severe myopia, seen in 90% of one intermittent-exotropia group [squint] - Lower-lid indentation on downgaze during torchlight exam can support a keratoconus diagnosis - Nuclear sclerosis of the lens can paradoxically sharpen unaided near vision in older adults - Above 1.5 D of myopia, the retinoscopy reflex moves opposite to the streak light TESTS (6) - Cycloplegic retinoscopy in children removes accommodative spasm before measuring refractive error - Autorefractometers measure refractive error using infrared light near 800 to 900 nm - Corneal topography screens for keratoconus before laser refractive surgery - OCT is recommended in moderate to high myopia to catch early retinal change - Wide-field fundus photography documents peripheral retinal disease such as lattice degeneration - Cycloplegic refraction separates pseudomyopia from true myopia once accommodation is fully relaxed IF NOT THIS - what else fits (7) - Pseudomyopia is a reversible increase in myopic error from ciliary spasm, not true axial growth - Lenticular myopia from early nuclear sclerosis is a secondary cause, mainly in older adults - Uncontrolled diabetes can cause a variable myopic shift from lens edema that resolves with glucose control - Marfan, Stickler, or Ehlers–Danlos syndrome can cause axial elongation from connective tissue defects - Posterior lenticonus, sometimes linked to Alport syndrome, is a rare mimic - A slanted myopic disc must be told apart from congenital optic disc hypoplasia or coloboma - High-myopia peripapillary atrophy can be mistaken for early glaucomatous change Source StatPearls "Myopia" - disease-level clinical article Status traced to the source above Rx: Main treatment | Myopia CONTROL in a child - slows progression; it does not correct vision MAIN TREATMENT 1. CORRECT THE REFRACTION, THEN CONSIDER MYOPIA CONTROL (RECOGNITION & REFERRAL)[1st line] Adult Common refractive error, especially in children and young adults. The definitive management is OPTICAL - spectacles or contact lenses correct the vision, and defocus- designed spectacle lenses, dual-focus soft contact lenses or orthokeratology additionally slow the eye from lengthening in a child. The article draws the line between the two: ordinary spectacles, soft lenses and rigid gas-permeable lenses sharpen sight but do not change how the myopia progresses over years, while the newer optical designs - dual-focus soft lenses, spectacle lenses that shift peripheral defocus, and orthokeratology - do slow the axial elongation itself in children. In a child whose myopia is progressing, low-dose atropine is the drug that belongs beside those - see the row below. - Refer Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Common refractive error, especially in children and young adults. The definitive management is OPTICAL - spectacles or contact lenses correct the vision, and defocus- designed spectacle lenses, dual-focus soft contact lenses or orthokeratology additionally slow the eye from lengthening in a child. The article draws the line between the two: ordinary spectacles, soft lenses and rigid gas-permeable lenses sharpen sight but do not change how the myopia progresses over years, while the newer optical designs - dual-focus soft lenses, spectacle lenses that shift peripheral defocus, and orthokeratology - do slow the axial elongation itself in children. In a child whose myopia is progressing, low-dose atropine is the drug that belongs beside those - see the row below. Caution Glasses or contact lenses are the treatment for the refractive error itself; no drug replaces them. The atropine row on this card is myopia CONTROL in a progressing child - a separate purpose, started by an ophthalmologist, and at a concentration Egypt does not register. RED FLAG - Sudden onset floaters, photopsia (flashes), or a curtain-like visual field defect warn of retinal tear or detachment. Why controlling progression matters - the point of managing it early is to keep the child from reaching high, or pathological, myopia, where the loss of vision cannot afterwards be undone. (Myopia - StatPearls - NCBI Bookshelf, NBK580529) High myopia carries a much higher lifetime risk of retinal detachment. RED FLAG - A sudden increase in floaters or flashes of light, especially in high myopia (raised retinal detachment risk), or rapid worsening of vision. MYOPIA CONTROL IN A CHILD - SLOWS PROGRESSION; IT DOES NOT CORRECT VISION - give alongside 2. ATROPINE [add-on - not a substitute] Adult NOT AN ADULT TREATMENT - this is a paediatric myopia-control regimen. The licensed product is atropine sulfate 0.1 mg/mL (0.01%): one drop into EACH eye once daily, at bedtime. It slows progression; it does not correct the refractive error, so glasses or contact lenses are still needed. - Years, with regular review; taper and stop once myopia is stable (less than 0.5 D progression over 2 years) in adolescence, then monitor for a further year Peds 3 to 14 years: One drop of atropine sulfate 0.1 mg/mL (0.01%) into each eye once daily, at bedtime. Not established below 3 years. (THIS IS THE PAEDIATRIC ROW. One drop of atropine sulfate 0.1 mg/mL (0.01%) into each eye once daily, at bedtime. Label verbatim on who it is for: "Treatment may be initiated in children aged 3-14 years with a progression rate of 0.5 D or more per year and a severity of -0.5 D to -6.0 D." Not established below 3 years.) Source Ryjunea 0.1 mg/ml eye drops, solution (atropine sulfate) SmPC sections 4.1, 4.2, 4.3 and 4.4 (eMC product 102228, emc-ryjunea-atropine-0.01pct.txt) Why Nothing was prescribed for myopia here, which is true of the refractive error and false of myopia control in a progressing child. The article treats low-dose atropine as central to managing myopia rather than optional, and records that the World Health Organization, the International Myopia Institute and national ophthalmology bodies all back atropine where a child's myopia is progressing; a licensed UK product states the same indication and the dose. THE STRENGTH IS THE WHOLE POINT: 0.01%, not the 1% Egypt registers. The two Egyptian 1% eye drops are excluded from the brand list here for that reason, so the row deliberately shows no Egyptian product; the 0.01% concentration has to be specially prepared or imported. Caution STRENGTH WARNING - THE ONLY ATROPINE EYE DROPS REGISTERED IN EGYPT ARE 1%, WHICH IS ONE HUNDRED TIMES THIS DOSE. 1% atropine is a cycloplegic/mydriatic for refraction and uveitis, not a myopia-control drug, and giving it nightly to a child would cause prolonged cycloplegia and photophobia. The Egyptian 1% products are deliberately excluded from this row's brand list. The 0.01% concentration must be specially prepared or imported. CONTRAINDICATED - the label bars it in: known hypersensitivity to atropine sulfate itself, or to any excipient the product contains, of which section 6.1 carries the list; known hypersensitivity to other anticholinergic drugs, tiotropium and ipratropium among them; and glaucoma, whether primary or angle-closure. Expected effects - the label says to expect trouble with accommodation and a greater sensitivity to bright light, both of them following from the pupil dilating. It can persist as long as 14 days. Photochromatic lenses are an option where the photophobia is uncomfortable. Stopping it can backfire. The label warns that myopia may rebound and progress again once the atropine drops are stopped, so keep the child under review for a year after treatment ends. Started by an ophthalmologist. The label restricts who may start it: an ophthalmologist, or another practitioner for whom myopia falls inside their scope of practice. How to give it - press on the lacrimal sac at the inner corner of the eye for a minute after the drop, which occludes the punctum and cuts how much is absorbed into the body. Contact lenses out before the drop, back in after fifteen minutes. Which concentration - the randomised evidence, the LAMP trial, Low-Concentration Atropine for Myopia Progression, among it, shows atropine at 0.05%, at 0.025% and at 0.01% all slowing the refractive change and the lengthening of the eye, though by different amounts: the stronger the drop the greater the effect, and the more side effects with it, photophobia and weakened accommodation among them. Followed over time, 0.01% shows very little rebound once it is stopped, which is why a number of countries reach for it first. It is an ADD-ON, not a substitute for correction. Glasses or contact lenses still correct the vision; this only slows the eye from getting longer. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)