Is Scleral Tattooing A Safe Practice? A Case Report

Describe a clinical case that shows a current practice among the young population that can have serious consequences for the world of ophthalmology.

Nowadays it is increasingly common to find people with the conjunctiva of both eyes in different shades. It has become a common practice to inject pigment into the bulbar conjunctiva, and in most cases it is not done in certified locations. It is therefore important, to analyse the consequences of this new trend and whether it is safe in the short and long term.

We present the case of a 27-year-old woman who came to the emergency department with thoughts of hopelessness and self-harm, as well as multiple tattoos all over her body. At the time she was in a state of high anxiety despite the prescribed medication, and requested hospital admission; during this time she was referred to the ophthalmology department.

The patient reported a progressive decrease in visual acuity in both eyes, a feeling of pressure and constant headache. The clinical manifestations started two weeks before the patient was admitted to the hospital.

On initial presentation, corrected visual acuity was 20/25 and intraocular pressure was 16 mmHg in both eyes.

There were no signs of anterior chamber inflammation or lens abnormalities and The funduscopy was normal. Both bulbar conjunctiva showed a bluish pigment including deep planes, as well as a whitish area which according to the tattooist was a latex residue that had entered with the injection. There was also an area of inferior temporal corneal thinning in both eyes with positive fluorescein uptake.

During admission, an optical coherence tomography scan was performed to analyse the patient's macula and optic nerve, and Tobradex eye drops were prescribed every 8 hours until the examination. At the subsequent re-evaluation, the corneal erosions had diminished, the patient's mental health was better and she did not want to follow up, but the multiple complications that could occur were emphasised.

The common practice of scleral tattooing is often associated with a characteristic patient profile, it is vital to be aware of the short and long term complications such as intraocular infection or conjunctival perforation as most people who attend are unaware of the extent of the damage. It is the job of the professionals to inform about them and to report cases in order to further the study of trends that are becoming increasingly common in our society.