FYI : Scleral tattooing is fraught with risks

The trend of getting a tattoo is a never-ending one. While some enjoy getting different tattoos on their bodies, there have been people who enjoy cosmetic tattoos. However, another type of tattoo is becoming popular. And, as frightening as it may sound, it’s scleral tattooing, or tattooing on the white part of the human eye. The Pioneer’s Tejal Sinha spoke to ophthalmologists and a tattoo artist, who not only spoke about the risk but also why getting such a tattoo is very rare in India.

Tattoos are something that’s never off-trend. Tattoos have become increasingly popular, whether they are small or cover an entire body.But how do we know something is in style? No doubt, it’s because of social media. And guess what the recent tattoo trend is? Scleral tattooing is the practise of tattooing the sclera, or the white part of the human eye. In this case, the dye is not injected into the tissue but between the two layers of the eye, where it spreads out over a large area.While this might not actually be a trend in India, influencers from other countries have seen people getting these tattoos. And you know what? Their comments section is filled with queries related to getting such tattoos. 

According to a study published in the American Journal of Ophthalmology Case Reports, “Using the outcomes of 2 cases of scleral tattooing with insulin needles and pen ink and a literature review of previously reported cases, investigators found that those who undergo these risky body modifications should receive a thorough evaluation with a dilated fundus exam because of potential globe penetration. We caution patients against the practise of scleral tattooing due to the very real danger of permanent blindness or loss of an eye and advise patients to seek medical attention immediately for any adverse events.”

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) considers eyeball tattooing a high-risk procedure and recommends that it only be performed by a doctor when medically indicated, such as for specific eye abnormalities. RANZCO advises against eyeball tattooing for cosmetic purposes, as they describe it as “…an extremely dangerous, irreversible procedure that can lead to blindness.”

There are many potential health risks from undergoing eyeball tattooing. Speaking to The Pioneer, Dr. Sudhakar Potti, CMO, Sankara Eye Hospital, Guntur, said, “Scleral tattooing is a procedure with no medical indications. It is a procedure fraught with many risks that is banned in certain states.The risk of corneal infection, the risk of reaction to the dye, the risk of globe perforation and toxic endophthalmitis, and the risk of permanent loss of vision and eye contour are some of the risks. Its long-term effects have not been studied in a systematic way. No one has approached us for scleral tattoos.

Even if they would, I’d strongly dissuade them from doing so.”
Recently, Karan Sidhu, a professional tattoo artist, underwent a surgery called ‘sclera staining’ in which ink is permanently injected into the whites of the eyes.An eye specialist in New York told him the surgery was highly risky and would be painful, but he chose to get it done.Doctors were vehemently against it. Also in 2017, Paul Freund, MD, and Mark Greve, MD, from the University of Alberta in Canada, reported on a tragic case.

A 24-year-old man underwent an eyeball tattoo procedure and experienced a sudden, painful loss of vision while the tattoo artist was injecting ink into the first eye. Meanwhile, Dr. Sudha Ramchandren, an ophthalmologist in Hyderabad with over 20 years of experience, elaborated on the risks. She said, “You’re essentially allowing an artist (tattoo artist, a body modification artist, or whatever you prefer to call them) to poke a needle into your eye several times and inject the dye. The risk is very real. When it goes wrong, it’s really wrong. There are plenty of safer ways to decorate your body. Having coloured eyes can be cool, but there are safe contacts you can wear — and you can take them out anytime you’d like. Opting to dye your eye is as risky as it sounds, and the damage can be very real.”

She further shared, “In case one really wants to change the look of their eyes, one can consult their ophthalmologist. The eyes are one of the most sensitive senses in the human body. Any kind of unnecessary experimentation with your eyes can be really hazardous. Now, even with contact lenses, it is not recommended to use them without the doctor’s guidance or approval. Being unaware of the reactions that can be caused, one might even lose their eyes forever.”

But do the tattoo artists themselves believe that the procedure is safe?

M. Shivesh, a tattoo artist says, “I personally have any experience, procedure or know the right process of doing anything with the eye. Especially in India, you will rarely find any tattoo artists who would be doing this. There’s no denying that tattoo art is beautiful; however, it needs to be done in a safer manner. There are people who wish to get rid of the tattoos that they had made on their hands, legs, or chests. If one actually gets such a tattoo, they’ve got no other option but to regret it later and at the same time suffer with the risks too.”

According to the information by NSW health, a government website, the risk of eye tattoos include

Perforation of the eye which can lead to blindness (the sclera is less than one millimetre thick).

Retinal detachment leaving the patient blind.

Endophthalmitis (infection inside the eye, that can lead to blindness).

Sympathetic ophthalmia (an autoimmune inflammatory response that affects both eyes and can result in blindness).

Transmission of blood-borne viruses from unsterile equipment.

Bleeding and infection at the injection sites.

Delayed diagnosis of medical conditions as the true colour of the sclera is now hidden (for example jaundice is often the first symptom for many diseases).

Sensitivity to light.

Adverse reactions to the ink.

Attaining of the surrounding tissue due to ink migration.