Low-Dose Atropine Eye Drops for Excessive Tearing (Epiphora)

Inclusion criteria

• Adults 18 years of age or older
• Symptomatic epiphora (unilateral or bilateral) with tearing requiring eyelid wiping or dabbing at least 2 times per day (Munk score ≥2)
• Epiphora attributed to functional/idiopathic, gustatory, environmental, or lacrimal outflow (e.g., nasolacrimal duct obstruction, punctal stenosis) etiology
• Visual acuity of 20/200 or better in at least one eye (with habitual correction or pinhole)
• Willing and able to self-administer eye drops nightly for 7 days in each of two treatment periods and attend all study visits
• Prior use of topical atropine permitted if at least 10 days have elapsed since the last dose

Exclusion criteria

• Clinically significant dry eye disease, or tearing judged to be a reflex response to ocular surface disease, blepharitis, or other ocular surface irritation
• Regular use of artificial tears, ocular lubricants, or dry eye medications, or unwillingness to stop them during the study
• Active or recent (within 30 days) ocular infection, or active dacryocystitis
• Current use of ophthalmic anticholinergic agents (unless stopped at least 10 days before Visit 1)
• Hypersensitivity to atropine, other anticholinergics, or any component of the formulation
• Angle-closure glaucoma or narrow anterior chamber angles
• Pregnancy or breastfeeding
• Participation in another interventional study within 30 days
• Any condition or medication that, in the investigator's judgment, would interfere with study assessments or subject safety