Cyclogyl Shortage: What Providers and Prescribers Need to Know in 2026

The cyclopentolate hydrochloride (Cyclogyl) shortage has now stretched across multiple years, reshaping clinical workflows at ophthalmology and optometry practices across the country. While supply has improved from the crisis levels of 2023-2024, the FDA continues to list cyclopentolate as being in active shortage as of 2026. This guide is designed for eye care providers and prescribers managing cyclopentolate availability in their practice.

Current Shortage Status and Supply Chain Overview

The shortage originated when Akorn Pharmaceuticals ceased operations in February 2023 following bankruptcy. Akorn was one of the largest manufacturers of generic ophthalmic solutions in the U.S. Their permanent closure removed a substantial portion of national cyclopentolate supply.

Three manufacturers now serve the U.S. market:

Alcon Laboratories — produces brand-name Cyclogyl in 0.5%, 1%, and 2% concentrations

Sandoz — has increased generic production since 2024; currently the most significant generic supplier

Bausch Health — produces generic cyclopentolate; supply has been intermittent

A three-manufacturer market is inherently fragile. Any production issue, quality hold, or distribution delay at one facility can quickly cascade into local or regional shortages. Practices in some geographic areas have seen more stable supply than others.

Clinical Implications for Your Practice

The clinical impact of the cyclopentolate shortage extends beyond simple inconvenience. Key considerations include:

Pediatric cycloplegic refraction accuracy: Substituting a weaker cycloplegic like tropicamide for high hyperopes or strabismic patients risks underestimating the true refractive error. The AAO recommends 1% cyclopentolate for children aged 1-12 as the standard of care.

Amblyopia and strabismus management: Inaccurate cycloplegic refraction can lead to under-correction of significant hyperopia, which may delay treatment for amblyopia or accommodative esotropia.

Uveitis treatment: Cyclopentolate is also used therapeutically to break posterior synechiae and provide ciliary body rest in anterior uveitis. Alternatives include homatropine and atropine.

Scheduling disruptions: Practices that rely on a consistent supply for high-volume pediatric clinics may face significant scheduling challenges when stock is unavailable.

Evidence-Based Substitution Protocols

When cyclopentolate is unavailable, the following substitution framework — based on published literature and specialty society guidance — may help:

Adults and older adolescents: Tropicamide 1% is generally adequate for routine dilation and fundus examination.

Pediatric non-strabismic patients without significant hyperopia: Tropicamide 1% may be acceptable per the American Optometric Association, with documentation of the substitution rationale.

Pediatric patients with strabismus, amblyopia, or significant hyperopia: Reschedule for cyclopentolate if possible, or consider atropine 0.5% or 1% administered as drops 1-3 days before the exam.

Infants (under 6 months): Cyclomydril (cyclopentolate 0.2% + phenylephrine 1%) per AAO recommendations; if unavailable, consult pediatric ophthalmology.

Supply Management Strategies for Your Practice

Based on the current supply environment, these strategies can help reduce disruption:

Source from multiple distributors. Don't rely on a single wholesale supplier. Different distributors may have access to stock from different manufacturers at different times.

Consider ordering both brand and generic. Brand-name Cyclogyl from Alcon may be available when generic cyclopentolate is not, despite being more expensive.

Maintain a buffer inventory. Given the unpredictability of the shortage, keep enough stock on hand for at least 2-4 weeks of expected use.

Help patients source their own supply when needed. For cases where patients need to pick up cyclopentolate at a retail pharmacy, recommend they use medfinder to locate which pharmacies have it in stock. medfinder contacts pharmacies near the patient to check availability.

Check with hospital or health system pharmacies. Affiliated hospital pharmacies often have access to different supply channels and may have stock when commercial distributors don't.

How to Help Your Patients Navigate the Shortage

For a detailed guide on helping your patients locate cyclopentolate and navigate cost barriers, see our companion post: How to Help Your Patients Find Cyclogyl in Stock: A Provider's Guide. You can also direct patients to medfinder.com/providers for resources to share with your practice.