アトロピン点眼液で副作用が発現した小児への眼軟膏の有効性

Efficacy of atropine ophthalmic ointment in children who developed side effects from eye drops: a case report

要約　目的：小児の屈折は，アトロピン硫酸塩（以下，アトロピン）を使用し，十分な調節麻痺下で測定する必要がある。アトロピン点眼液は，副作用の発現のために十分に実施できない例も多い。今回，点眼液で副作用を認めた症例に対し，アトロピン眼軟膏に切り替えることで，副作用が発現しなかった症例を経験したので報告する。

対象と方法：2022年4月〜2024年3月にアトロピン点眼液を用いて屈折検査を行った192例を対象とした。

結果：アトロピン点眼で14例（7.3％）に副作用がみられ，このうち5例にアトロピン眼軟膏を用いて再検査をした。以下に詳細に経過観察できた2症例について述べる。症例1は4歳，女児。右眼に洗剤が入ったため当科を受診した。初診時視力は右（1.2），左（0.3）であった。左不同視弱視を疑い，屈折検査を目的にアトロピン点眼液を処方したが，点眼後すぐに副作用が発現した。アトロピン眼軟膏を再処方し，副作用の発現なく屈折検査を終了した。症例2は4歳，女児。右内斜視を指摘され，当科を紹介受診した。初診時視力は右（0.15），左（0.8）であった。右内斜視と不同視による弱視を疑い，屈折検査を目的にアトロピン点眼液を処方したが，点眼後に発疹を認め中止した。その後，アトロピン眼軟膏を再処方し，副作用は認めなかった。その他の3症例についても，アトロピン眼軟膏では副作用の発現なく屈折検査を終了した。

結論：アトロピン眼軟膏は，点眼液で副作用の既往がある小児に対して有効な代替方法であることが示された。

Abstract　Purpose：Atropine sulfate（“atropine”） is used for refraction testing in children, and measurements should be collected under appropriate cycloplegia. However, since atropine eye drops have a variety of side effects, they cannot be administered in some cases. In our clinic, we experienced five patients with side effects which made us switch to atropine eye ointment usages which successfully enabled us measure refraction without side effects.

Subjects and methods：We studied 192 patients who received cycloplegic refraction test using atropine eye drops between April 2022 and March 2024.

Results：Side effects due to usages of atropine eye drops were found in 14 cases（7.3％） among which we used atropine eye ointment for cycloplegic refraction tests. We shall describe clinical details of representative 2 cases in which the refraction test was successfully performed without side effects. Case 1 was a 4-year-old girl who visited our clinic after accidentally getting detergent in her right eye. Her visual acuity at the initial examination was Vd＝（1.2） and Vs＝（0.3）. Since left anisometropic amblyopia was suspected, atropine eye drops prescribed. However, she immediately developed side effects which made us to switch to atropine eye ointment which enabled us to perform refraction testing completely without side effects. Case 2 was a 4-year-old girl who was referred to our clinic because of right esotropia was noted by her family doctor. At the initial visit, her visual acuity was Vd＝（0.15） and Vs＝（0.8）. Since right esotropia and anisometropic amblyopia were suspected, atropine eye drops were prescribed. However, it was terminated as the patient developed rash soon after the usage of the eye drops, which made us to switch to eye ointment and refraction testing was completed without side effects. In other 3 cases than the representative cases, refraction testing with atropine eye ointment was performed without side effects.

Conclusions：Application of atropine eye ointment is an effective alternative for refraction testing under cycloplegia in children with a history of adverse reactions to the eye drops.