Tattoo you: Scleral tattoos pose threat to eye health

September 29, 2020

A French kindergarten teacher has lost his job after the parents of a child complained about his appearance, which includes multiple face tattoos, including the sclera of his eyes, which have been turned to black by the ink. Scleral tattoos pose a serious threat to eye health, and could be a challenge for ophthalmologists treating these patients.

A French kindergarten teacher has lost his job after the parents of a child complained about his appearance, which includes multiple face tattoos, including the sclera of his eyes, which have been turned to black by the ink.

CNN reported this week that Sylvain Helaine, 35, lost his kindergarten teaching job as a result of his multiple tattoos. Over the past several years, he has covered his face in tattoos, including turning his eyes black. He told the network he started getting tattoos when he was 27.

According to a Reuters report, the parents of a child at the Docteur Morere Elementary School in Palaiseau, a Paris suburb, complained to school officials. They claimed their child had nightmares after seeing Helaine.

An innocent tattoo can often be a rash decision and eventually one a person may regret. According to a recent Ipsos poll, 3 in 10 (30%) of Americans have at least one tattoo, an increase from 21% in 2012. Tattooing the skin is a tried-and-true process that is relatively safe. While body tattoos are common today, less common is tattooing the sclera to add color to the eye.

John A. Hovanesian, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO), and surgeon at Harvard Eye Associates in Laguna Hills, California, noted that there are plenty of risks associated with eyeball tattoos. Complications associated with the tattoos could provide new challenges that ophthalmologists may have to face in their practices.

“Our body's skin is thick enough to absorb tattoo ink, but the eye is so thin, that even tiny tattoo needles will penetrate the surface causing permanent and painful blindness,” Hovanesian said.

According to the AAO, these risks include decreased vision or complete blindness; injection from the injection or ink; retinal detachment; inflammation of the eye; a continual sensation that something is in the eye; and sensitivity to light. In a worst-case scenario, an individual could lose his or her eye.

According to the AAO, eyeball tattoos have not been studied either medically or scientifically. The process also was not developed by a physician. In the process, a tattooist will inject ink just below the surface of the conjunctiva to color the sclera.

However, the AAO noted that there is a small margin of error. If the needle is not positioned properly, the ink can instead be injected inside the eye, onto the retina or into tissue surrounding the eye. These mistakes can have dire consequences to the individual receiving the tattoo.

“It is particularly devastating to any patient who decides to have their eyes tattooed, as removing the eye might be the only way to reduce the incredible pain that would frequently follow this ghastly procedure,” Hovanesian said. “It is not worth it. It would be tragic to lose your sight. ” 

The process also is not a traditional part of tattooing. As a result, there is no training, licensing or certification for tattooists performing this procedure, according to the AAO.

A study reported in the European Journal of Ophthalmology highlighted the dangers. A 21-year-old woman went to the emergency room complaining about pain in her right eye and photophobia 3 weeks after receiving a scleral tattoo.1

According to investigators, a slit-lamp examination was performed, revealing right-sided eyelid edema and black deposits of tattoo ink under the bulbar conjunctiva.

“Dye deposits were also present in anterior chamber, covering corneal endothelium, iris and anterior lens' capsule. Ocular inflammation and secondary glaucoma were diagnosed,” the investigators wrote. “The patient underwent surgical treatment to control ocular inflammation.”

Scleral tattooing has been banned in four states, including Indiana, Utah, Washington, and Oklahoma. The process also has been banned in the Canadian provinces of Ontario, Saskatchewan, and Manitoba

REFERENCE:

Tubek K, Berus T, Leszek R. The girl with the eyeball tattoo-what the ophthalmologist may expect? Case report and a review of literature Eur J Ophthalmol. 2019 Sep;29(5):NP1-NP4. doi: 10.1177/1120672118803855.