Penalization, atropine

Box 33-2 Advantages, Indications, and Contraindications for Atropine Penalization in the Management of Amblyopia... 

Arnold RW, Gionet E, Hickel J, et al. Duration and effect of single-dose atropine paralysis of accommodation in penalization treatment of functional amblyopia. Binocul Vis Strabismus Q. 2004 19 81-86. 

Treatment of Amblyopia. Atropine can be used as an alternative to direct occlusion in the treatment of amblyopia. This form of amblyopia therapy is referred to as penalization and is often combined with optical overcorrection or undercorrection to blur the better eye for distance or near vision or both.The resultant cycloplegic blur in the eye with normal vision often forces the patient to use the amblyopic eye when the vision in the good eye is rendered poorer than that of the amblyopic eye.Thus this treatment is often reserved for moderate and mild amblyopia (acuity better than 20/100 in the amblyopic eye). Renewed interest in this form of therapy has been expressed because of its potential for improved compliance and stimulation of binocular function. Although pharmacologic occlusion can improve visual acuity in amblyopic eyes, care is needed because penalization can result in amblyopia in eyes with normal acuity. 

Simons K, Stein L, Sener EC, et al. Full-time atropine, intermittent atropine, and optical penalization and binocular outcome in treatment of strabismic amblyopia. Ophthalmology 1997 104 2143-2155. 

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