Deepika Biswakarma, M.Optom

Optometrist, Suvidha Optician, Jammu & Kashmir, India

Tattoos are very common and practised across the globe. Many people in the thrill of being extraordinary, undergo extreme body modification where they engrave tattoos on the eye. When I talk about cost, I am not referring to the money that you pay for having a tattoo. What I am talking about here are those ocular complications and risks that you might encounter during or after the procedure.

Eyeball tattooing is permanent inking of white part of the eye (sclera), also named as Scleral tattoo. There is no training or licensed procedure for this nor is it performed traditionally by eye care professionals instead these are done by tattooists. They inject ink in multiple positions under the thin conjunctival layer, thereby eventually spreading all over the sclera.

It is not safe and announced as illegal act in many countries like Nebraska, Oklahoma, Indiana, Canadian province of Ontario and Washington etc.⁽¹⁾ Only licensed doctors are allowed to perform eyeball tattoo if only medically indicated, recommended by RANZO (The Royal Australian and New Zealand College of Ophthalmologists).⁽²⁾

Being highly risky, it may ultimately cause blindness or even one may lose the entire eye.⁽¹⁾ Any mistakes like injecting a needle in the wrong place or into the retina can lead to consequences. The main causes of all the complications are toxicity, adverse reaction to ink and infection/ inflammation on the site of the ink injected area. Also, blood borne viruses can transform from non-sterile needles.

Following are the current known complications

• Inflammation of sclera
• Irritation/Foreign body sensation
• Sensitivity to light
• Decreased vision
• Severe ocular pain
• Swelling, staining of the skin tissue around the eye (Figure 2)
• Corneal stain (if penetrate cornea ignorantly)
• Staining of vitreous (If injected deeply into vitreous)
• Traumatic cataract (If needle penetrates the lens)
• Retinal detachment
• Endophthalmitis (Internal eye infection)
• Systemic Ophthalmia (Bilateral granulomatous anterior/posterior uveitis) ⁽²⁾
• Pigmentation & Atrophy of Iris ⁽³⁾
• Secondary glaucoma ⁽⁴⁾
• Orbital cellulitis ⁽⁵⁾
• Enucleation of eye (Due to total damage and severe pain in eye)

Figure 1: Massive inflammation with green discoloration of right eye
Picture courtesy: https://marianaseye.com/eye-tattoos-cause-complications/

The long-term risks are currently unknown. ⁽²⁾

Due to all such possible ocular complications, Public Health Act 2010 has prohibited eyeball tattoo until and unless performed by a medical professional when medically indicated. ⁽²⁾ Any individual found to do the procedure unlawfully will be fined with maximum penalty of $11,000- or 6-month imprisonment. ⁽²⁾

It is stated that many people are influenced by social media where untrained individuals perform successful eyeball tattoos with ease, but this is not a real case scenario. ⁽³⁾ There are a series of cases of eyeball tattoos gone wrong. Even if it went right, the scleral tattoo makes it difficult for doctors to examine your eye health in future.

Now, I want you to seriously consider all the health costs mentioned above that you might pay and ask yourself a question, is this cost worth paying for just a better appearance or on the name of trend?

In nutshell, the urge of looking different that can cost your eyes permanently are not worthy.  You only get one set of eyes with which you should not mess up by following the trend. Instead, one can use tinted contact lenses as an alternative to change their cosmetic appearance.

The eye is the jewel of the body. So, everybody should protect and take care of it.

References:

1. Eyeball Tattoos Are Even Worse Than They Sound. (2019, August 29). American Academy of Ophthalmology. [Available at: https://www.aao.org/eye-health/tips-prevention/eyeball-tattoos-are-even-worse-than-they-sound, Last accessed- 14 May 2023;14:30AEST]
2. Eyeball tattooing Fact sheets.(n.d.). Available at: https://www.health.nsw.gov.au/environment/factsheets/Pages/eyeball-tattooing.aspx Last accessed- 14 May 2023;14:36AEST]
3. Shalini, B., Nair, A. V., Periasamy, M., Kumarswamy, K., & Dsouza, P.N. (2022). Inadvertent globe penetration due to self-attempted eyeball tattooing. Indian Journal of Ophthalmology-Case Reports, 2(1), 128.
4. da Cruz, N. F. S., Santos, K. S., de Lima Farah, M., & Felberg, S.(2017). Conjunctival tattoo with inadvertent globe penetration and associated complications. Cornea, 36(5), 625-627.
5. Duarte, G., Cheja, R., Pachón, D., Ramírez, C., & Arellanes, L. (2017). Case series: Two cases of eyeball tattoos with short-term complications. American Journal of Ophthalmology Case Reports, 5, 26-28.

Cover Picture courtesy: https://www.vlanj.org/eyeball-tattoos-a-new-dangerous-fad/