Understanding the Dual Ocular Impact of Atropine

Clinicians worldwide frequently prescribe atropine for myopia control to slow axial elongation in children. While this treatment is highly effective, evidence suggests it may inadvertently induce or exacerbate dry eye disease (DED). A recent study utilizing network pharmacology and molecular dynamics simulations has shed light on this clinical paradox. Specifically, researchers investigated whether the therapeutic targets for myopia overlap with those causing ocular surface side effects.

Identifying Shared and Specific Molecular Targets

The research identified two distinct categories of targets involved in atropine for myopia control. Class I targets represent shared mechanisms between myopia and dry eye disease. These include EGFR, MMP2, MMP9, and MAPK1, which converge on inflammatory and extracellular-matrix-remodelling pathways. Moreover, these shared targets suggest that the same biological signals slowing eye growth may also disrupt the delicate balance of the ocular surface. Consequently, this overlap explains the high incidence of dry eye symptoms in treated patients.

In contrast, Class II targets appear specific to myopia progression. Examples such as PIK3R1 and AKR1B1 were prioritised through retinal and pan-ocular expression data. Furthermore, molecular dynamics simulations confirmed that atropine forms stable complexes with these proteins. Therefore, targeting these myopia-specific pathways could potentially lead to more refined treatments. This approach might allow for effective axial length management without compromising tear film stability.

Clinical Implications for Eye Care Professionals

These findings provide a biological framework for understanding why some patients struggle with atropine therapy. Additionally, the study generates testable hypotheses for future translational research. Practitioners should monitor the ocular surface closely when using atropine. Implementing preventative ocular lubricants or adjusting concentrations may help manage these side effects. Ultimately, this research paves the way for developing next-generation agents with improved safety profiles.

Frequently Asked Questions

Why does atropine treatment sometimes lead to dry eye disease?

Atropine affects shared Class I targets like MMP9 and EGFR. These proteins regulate both the eye\'s growth and the health of the ocular surface. When these pathways are modulated to control myopia, they can simultaneously trigger inflammation and dryness.

Can we separate the anti-myopic effects of atropine from its side effects?

The identification of Class II targets suggests that it is theoretically possible. Future drug development may focus on molecules that specifically interact with myopia-prioritised targets like PIK3R1 while avoiding the inflammatory pathways linked to dry eye.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare provider regarding any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

• Lin M et al. Network pharmacology and molecular dynamics simulations reveal shared mechanisms and myopia-specific targets of atropine in myopia and dry eye disease. Eye Vis (Lond). 2026 Jun 22. doi: undefined. PMID: 42324572.


• Chia A, Lu QS, Tan D. Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with 0.01% versus 0.5% and 0.1% Atropine. Ophthalmology. 2016;123(2):391-399.


• Wu PC, et al. Update in Myopia and Treatment Strategy of Atropine Use in Myopia Control. Eye (Lond). 2019;33(1):3-13.