Beating Siahlorrhea: The use of Ophthalmic Atropine Sublingually

Sialorrhea is a common and challenging problem in a variety of patients. We describe the use and safety of ophthalmic Atropine for sialorrhea in the pediatric population.

Anti-cholinergic medications are used in an attempt to reduce the manifestations of sialorrhea. Many patients discontinue the medications due to intolerable side effects.

Our first patient, a 17 months old patient with congenital hypotonia complicated by dysphagia, was admitted to the Pediatric Intensive Care Unit at four months of age due to recurrent aspiration pneumonia and recurrent lung collapse. He remained ventilated mainly due to oral secretions comprising his airway. The patient was tried on ophthalmic Atropine sublingually which considerably reduced secretion production within 48 hours of initiation; suctioning time was reduced from hourly to every two hours. Increased lacrimation, hyperthermia, and flushing were the observed side effects at the maximum given dosages.

After six weeks of initiation, our patient was ultimately weaned off the ventilator requiring minimal supplementary oxygen when required.

Our second case is a 7-year-old cerebral palsy patient, whose stay in the Pediatric Intensive Care Unit was complicated by recurrent aspiration pneumonia and excessive oral secretions compromising his airway requiring intubation. He was started on ophthalmic Atropine sublingually and was extubated after a long period of mechanical ventilation. Secretion production was noticeably reduced after four days on the treatment. The patient’s side effects included flushing, increased lacrimation and tachycardia.

The subjects were selected based on the need for treatment. The dose selection was arbitrary; it was titrated until a satisfactory clinical response and minimum side effects were achieved. Both patients were successfully discharged from the Pediatric Intensive care, with minimal supplemental oxygen requirements when required.

Conclusively, we report the efficacy and possible side effects and of ophthalmic atropine sublingually; not an agent not commonly used in the pediatric population.