New Zealanders are the most “inked” nation in the world with approximately 1 in 5 having a tattoo.
A relatively new practice involves dying the white of the eye. Inks are injected beneath the conjunctiva and permanently colour the episclera, the other layer of the eyeball.
It is understandable that some people approach ophthalmologists to perform episcleral tattooing. We are very familiar with the tissues involved and the techniques required. In addition, we could perform the tattooing in a sterile surgical environment. Some patients are adamant they want the procedure and will have it anyway, potentially in a more risky environment. This puts pressure on surgeons to ‘do it better’.
At present it seems wise to resist such pressure, because above all we must ‘do no harm’. All tattoos have risks. The most common are localised infection and scarring but there are other well-documented problems such as late immune complications. At this stage the risks of episcleral tattooing are unclear. There have been reports of early complications including severe inflammation. The long term risks are that the inks could interfere with structures deeper within the eye, and in particular those which help continuously drain fluid from the eye, leading to chronic inflammation and glaucoma. Glaucoma is a potentially blinding disease. Some of the inks used contain metals such as copper, which are known to be highly toxic to parts of the eye, including the retina.
It is also important to remember that many people later regret having a tattoo, either as personal choice changes or due to discrimination. It is not possible to remove episcleral tattoos.
Over the last decade eyelid tattooing has become more common. In most cases the procedure is performed by a beauty therapist in order to create a permanent ‘eye-liner’.
Eyelid tattooing can damage the Meibomian glands, specialised oil glands located in the lid margin. Meibomian gland secretions are critical to the health of the eye. Gland dysfunction leads to dry eyes and chronic irritation. In some cases vision is impaired. There is no cure, although ongoing, and often costly treatments can help.
At present I advise patients not to have episcleral or eyelid tattoos. The risks are simply too high.