Case of the issue: Scleral Tattoo Gone Wrong

It’s always good to be aware of the latest trends that patients are partaking of in the name of style which may affect their health. This is one which I have only recently been made aware of, and as an Orlando eye surgeon, one that I very much hope does not catch on.

This case comes from Alberta, Canada, where a 24-year-old male presented with severe vision loss after a scleral tattoo procedure. Reportedly, a tattoo artist attempted to inject ink into the subconjunctival space with the goal of dying the sclera. The artist penetrated the globe with the tattoo needle and injected ink into the vitreous cavity after striking the crystalline lens with the needle. This patient, unfortunately, developed endophthalmitis, and despite vitrectomy and intravitreal antibiotics, lost the eye. 

(Clicking on any of the images below will redirect to an excellent short 2-minute video of the case with imaging, surgical video, and pathology slides.)

Figure 5. Green dyed sclera, edematous cornea, and anterior chamber filled with green dye impairing view of iris, lens, and posterior segment.

Figure 6. Surgical photo illustrating chemotic conjunctiva, subconjunctival green dye, injection, anterior chamber filled with dye

Figure 7. After entry incision to anterior chamber was made, green tattoo ink dye rapidly egressed from the eye

A brief google search showed that scleral tattoos, while quite uncommon, have been growing in popularity over the past decade. Oklahoma made performing scleral tattoos a misdemeanor in 2009, but elsewhere it appears that the tattoo artist community believes that their licensure covers performing of this procedure. I am not aware of any legal cases which litigated the matter. Let’s hope this doesn’t catch on in Florida! 

Freund, Paul et al. Scleral Tattoo Gone Wrong. May 2017. Available: https://www.aao.org/clinical-video/scleral-tattoo-gone-wrong