Myopia, or near-sightedness, is rapidly emerging as a major global health issue, with projections indicating that by 2050, it will affect nearly 50% of the world’s population. This condition arises from excessive elongation of the eyeball, leading to blurred vision at a distance and increasing the risk of severe ocular complications, such as retinal detachment and glaucoma. Effective management strategies are critical to mitigating the public health impact of this growing epidemic. Atropine, a muscarinic antagonist, has gained attention for its potential in myopia control. By inhibiting muscarinic acetylcholine receptors (mAChRs) in the eye, atropine slows down axial elongation, the anatomical hallmark of myopia. Low-dose atropine (0.01%) has demonstrated efficacy in clinical trials, such as the ATOM2 study, which showed a 50% reduction in myopia progression with minimal side effects, including photophobia and blurred vision. Meanwhile, the LAMP study indicates that slightly higher concentrations (0.05%) may further balance efficacy and tolerability, especially in children at high risk of severe myopia. Despite these promising results, critical knowledge gaps persist, particularly concerning atropine’s long-term safety, optimal dosing, and the rebound effect, where myopia progression may accelerate after stopping treatment. Ethnic and genetic variability also calls for a more diverse research focus. Future studies should explore combining atropine with other interventions, such as orthokeratology or multifocal lenses, to optimize outcomes. As leading pharmacological option for myopia management, atropine holds potential for integration into multifaceted treatment strategies to address this pressing public health concern.