Eyeball tattoos can carry risk of adverse events that usually occur within weeks, but one patient didn’t have problems until a full eight years later.
Ocular and peri-ocular tattooing has had a rise in popularity globally, according to a recent review article in the journal Diagnostics. Reasons include people wanting to look like movie characters or comic heroes, or bizarrely, wanting to dye their eyeballs with various colours – black, green, or red, for instance.
In this particular case, a patient had his conjunctiva tattooed so the white part of the eye would look black.
But after a swim in the Mediterranean while on holiday, he developed irritation in the right eye that initially felt like a scratch, wrote Zain Amir, MBChB, of the Moorfields Eye Hospital in London, and colleagues in BMJ Case Reports.
Further investigation revealed uneven distribution of the para-corneal tattoo pigment, which had accumulated at the nasal conjunctiva, they reported. Pigment distribution in the left eye was evenly distributed.
Amir and team ultimately diagnosed the patient with corneal dellen formation as a complication of conjunctival tattooing – the first such instance of it, they said.
“This is a novel presentation of ocular surface disease elicited from such practices, which differs from previous documented cases of post-ocular tattooing complications,” they wrote.
The doctors prescribed a long-term course of topical oculentum carbomer 0.25% gel and guttae sodium hyaluronate 0.15% with trehalose 3% drop lubricants.
Two months later, the patient had stopped the lubricants, and the symptoms had returned – so physicians encouraged good compliance and longer-term use of the treatments.
It’s not clear why his symptoms developed eight years after the tattoos, and how a swim in the sea could have contributed to them, the authors wrote.
“The patient is clear that symptoms starting after the exposure to sea water,” they noted. “This interaction causing a pro-inflammatory conjunctivitis leading to pigmentation redistribution is possible but would require further research to provide a causal link.”
They said patients who opt for conjunctival tattooing “should be alerted that the irreversible pigment jdeposition can manifest as unexpected long-term complications”.
Natalie Afshari, MD, chief of cornea and refractive surgery at the University of California-San Diego’s Shiley Eye Institute, said cases like this are extremely rare, but sometimes professional tattooing of the eye has a legitimate purpose – for example, if corneal blindness in one eye causes it to look white. Corneal tattooing can make both eyes look the same.
Contact lenses, if blind patients can tolerate them, can accomplish the same thing, and are reversible, whereas tattooing in the eye is permanent, she said.
But if patients want to tattoo their eyes simply to look strange, or resemble a comic book character, she advised against it, highlighting the risk that the ink might cause infection, inflammation, and mask other eye diseases, like melanoma, “and can even cause glaucoma in rare cases”.
“Tattoo ink is not intended to be underneath the conjunctiva.”
Some reports have documented a flurry of such cases among people who dyed their eyes blue to resemble characters in the science fiction movie Dune. There was also the case of a Canadian model, Cat Gallinger, who dyed her eyes purple but nearly went blind doing so.
Study details
Long-term complications of conjunctival tattooing: pigment aggregation and corneal dellen formation after eight years
Zain Amir, Safia Husain and Kamran Saha.
Published in BMJ Case Reports Volume 19
Abstract
We present a case of pigment clumping secondary to cosmetic conjunctival tattooing performed 8 years prior, which subsequently led to corneal dellen formation. This case highlights the delayed effect that ocular tattoo can have in exacerbating ocular surface disease.
MedPage Today article – Eyeball Tattoo Goes Sideways (Open access)
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