Think before you ink

HYDERABAD: Body modification is something that is growing more popular every day among youth. Various Body modification Procedures are being performed these days, among them, Eyeball tattoos are a relatively new extreme body modification which indeed gaining popularity.But one needs to be aware of eyeball tattooing as it has its own set of complications as Ophthalmologists around the world are experiencing increasing numbers of patients with blindness and eye loss because of the increasing popularity of eye tattooing.

Eye tattoos, which were first performed about a decade ago, could have a substantial number of short-term risks and long-term risks.In comparison, there is a practice called corneal tattooing that’s performed by an ophthalmologist in a sterile operating room with tested and regulated dyes.

In stark contrast, eye tattooing is being performed by untrained individuals who have no knowledge of the eye’s delicate anatomy in tattoo parlours has resulted in numerous severe short-term ocular complications by the needle stick penetration of the eyewall, This has been known to Hemorrhages, cataracts, retinal detachment and infections leading to Orbital Cellulitis, Posterior Scleritis and even endophthalmitis,,If the procedure is not done with strict aseptic measures and in a sterile environment can cause Tetanus, Hepatitis B, C, D and HIV as well.

According to FDA vast majority of the dye inks tested did not comply with international health safety standards for an ink composition, A European Commission noted that close to 40% of organic tattoo colorants used in Europe had not been approved for cosmetic use and that under 20% of colorants contained a carcinogenic aromatic amine. According to an Australian government-sponsored study, carcinogens were identified in 83% of black inks by far the most popular colour for tattoos.

These dyes contain industrial printer inks and automobile paints, and these dyes contain Iron, Mercury, cobalt, nickel, copper, chromium and Barium. All these elements can cause delayed hypersensitivity reactions and can sensitise uvea leading to recurrent Uveitis. Finally, the presence of a granuloma or episcleral nodules can promote long-term scleral thinning or can even lead to malignancy.

Chronic reactions occur with red ink and black inks. Purple, pink and orange colours have also shown adverse reactions. Red ink may cause severe tissue damage which may exacerbate to such an extent that the only option left is to remove the eye. The adverse effects of red ink are due to mercury, while black ink contains iron oxide. Red and yellow pigments, when exposed to sunlight, may trigger an allergic reaction causing redness and swelling of the eye.

The tattoo pigments may enter the lymphatic system and clog the lymphatic nodes and cause inflammation. The discoloured lymph nodes appear similar to those affected by a skin cancer called melanoma and may interfere with the staging of cancer. Metal-based ink tattoos can react with magnetic resonance imaging studies. And can cause MRI induced burns that were attributed to iron compounds in tattoo pigments. This past September, 24-year-old female model from Ottawa, Canada went to get white portion of her eye tattooed. The procedure didn’t go as planned, and her current condition threatens her vision. In her case, the tattoo artist used a needle to inject an unregulated purple dye under the outer layer of her eye. Subsequently, she felt terrible pain and now she’s at risk of long-term complications as a result of the botched tattoo.

Recently, the Eye Physicians and Surgeons of Ontario, Canada took the issue to the legislative assembly in an effort to amend Bill 160, the Strengthening Equality and Accountability for Patients Act. One needs to understand that removal of the tattoo from the eye is almost impossible, unlike skin tattoos.
So “Think Before You Ink” as this is permanent and associated with many risks or wait till the procedure and the dyes get standardized.

The doctor is a refractive, cornea and phaco surgeon, Maxivision Super Speciality Eye Hospital