AIM: To systematically evaluate the effect and safety of cyclopentolate and atropine on ciliary muscle paralysis before optometry in myopic children. METHODS: Relevant references published before April 2020, which concerned about cyclopentolate compared with atropine for ciliary muscle palsy in children with myopia, were obtained by searching PubMed, EMBASE, Web of Science, The Cochrane Library, CNKI and WanFang Database. For the selected studies, after data extraction and methodological quality evaluation of the included study, RevMan5.3 software was used for Meta-analysis. RESULTS: Nine articles were finally included, containing 588 eyes using atropine and 592 eyes using cyclopentolate. Meta-analysis results indicated: comparing of cyclopentolate and atropine for cycloplegia in children with myopia before optometry, the diopter difference between the two is WMD: -0.01, 95%CI(-0.30, 0.27), P=0.93; the difference in residual accommodation power between the two is WMD: 0.22, 95%CI(-0.13, 0.58), P=0.22. In addition, the cyclopentolate is safer and has a lower incidence of adverse reactions.CONCLUSION: Compared with atropine, cyclopentolate has equivalent effects on ciliary muscle paralysis in myopic children, and has higher security. Cyclopentolate could replace atropine for myopic children before optometry.