Introduction
Corneal tattooing (keratopigmentation) is tattooing the human eye's cornea. The reasons for this procedure include beauty enhancement and vision enhancement. There are several ways and processes available today, and there are differing views on the safety and effectiveness of this practice. Eratopigmentation, often known as corneal tattooing, is a centuries-old treatment used to enhance the aesthetic look of corneal scars and leukomas.
Keratopigmentation has also alleviated vision problems caused by corneal and iris defects. Several approaches have been devised to get the most significant practical and aesthetic effects, utilizing a range of ink pigments. This article addresses the history, indications, techniques, benefits, and risks of eye tattooing treatments, such as medically indicated corneal tattooing and the purely cosmetic body modification practice of eyeball (subconjunctival or episcleral) tattooing.
What Are The Indications of Corneal Tattooing?
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The causes for corneal tattooing differ from patient to patient. Following illness, most individuals have therapy to improve the cosmetic look of their eyes.
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Others are treated for optical reasons, such as reducing contextual glare within the iris. Corneal opacities are the most common reason for cosmetic tattooing.
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The most common cause for corneal tattooing is to modify the look of the eye cosmetically.
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The most common reason for this change is corneal opacity. Leucoma, keratitis, or cataracts can all induce corneal opacities (cornea scarring that results in an opaque or semi-transparent patch on the eye).
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Such opacities might be cosmetically bothersome to patients in their daily lives. Tattooing the cornea can change the appearance of discoloration by merging an opacity into the natural eye color.
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A viable treatment option in a subset of patients for whom non-surgical (for example, contact lenses) and reconstructive surgical techniques would not result in functional or cosmetic improvement.
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Corneal scars, leucomas, aniridia, polycoria, traumatic iris abnormalities, and iridodialysis are the most prevalent signs.
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Other applications mentioned in the literature include symptomatic glare or diplopia caused by laser peripheral iridotomies and persistent binocular diplopia.
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Most doctors believe the treatment should only be used on individuals who have lost their vision or do not expect to regain it.
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Corneal tattooing is used on rare occasions to improve vision. Treatment is indicated for albinism, aniridia, coloboma, iridodialysis, keratoconus, or dispersed nebulae of the cornea. Corneal tattooing is also used to treat symptomatic glare caused by extensive iridectomies or traumatic iris loss in individuals with vision.
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Keratopigmentation, for cosmetic purposes, is a procedure used to modify the color of a patient's eyes.
What Are The Techniques of Corneal Tattooing?
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The staining method is the direct application of tattoo ink to the cornea's front surface. The advantages include a quick technique and homogeneous color application. The greater impermanence of dye in this process results in a considerable danger of fading.
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Tattoo pigment is directly delivered into the ocular tissue via a needle puncture. The benefit is longer pigment retention, but the technique is more complex and time-intensive. Irregularly distributed pigment deposits can cause light scatter.
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Benefits of lamellar keratectomy include prolonged pigment retention and a decreased incidence of recurrent corneal erosions. Panda et al. evaluated a group of patients who had traditional (impregnation) tattooing vs lamellar pocket technique and found that the pigment density was higher, there were no instances of erosion, and none of the cases required repeat treatment after a year.
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FACT (femtosecond-assisted corneal tattooing) creates a shallow corneal pocket into which tattoo ink is introduced. The technique extends the life of the ink and produces more consistent cosmetic results. Dr. Keith Walter's femtosecond laser technology is demonstrated in this video.
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Tattoo ink selection is one of the fundamental drawbacks of corneal tattooing. Historically, There has yet to be systematic research proving the biocompatibility of colors and, as a result, the need for more trustworthy commercial supplies. In the literature, a wide range of sterile ink formulas have been described. Micronized mineral pigments are a newer pigment that has been found to offer an excellent aesthetic look without causing an inflammatory reaction or eye damage.
What Are The Complications of Corneal Tattooing?
The complexity of conducting the operation and the danger of the procedure are two of the downsides of corneal tattooing. Corneal tattooing is a challenging operation to do accurately. The tattooed region frequently fades over time and is rarely permanent. The size of the tattooed area may also shrink with time. When the outcomes are not what was intended, the eye may need to be re-tattooed. Also, due to the several incisions, the results may not endure very long, and the various lacerations may induce recurring corneal erosions. Finally, only some leucoma respond to tattooing. All leucomas do not react identically to intervention, which should only be performed on individuals with old, solid, and flat corneal cicatrices.
There are also some serious risks associated with corneal tattooing. Going blind as a result of the procedure's attempt is a risk. Some people report slight redness and the sensation of something in their eyes. The ink may not remain in the cornea and may induce keratitis. Other consequences include a toxic response, iridocyclitis, chronic corneal epithelial defects, and corneal ulceration. Physicians may also encounter issues like fading, size decrease, and short-term outcomes.
When injected into the eye, ink can move into the aqueous compartment, coating the lens, corneal endothelium, and trabecular meshwork. As a result, patients may develop a severe inflammatory foreign body response, uveitis, and secondary pigmentary glaucoma.
There is a large body of research on the immunological consequences of dermal and periorbital tattoos, such as uveitis. A hypersensitivity response to tattoo ink can cause nonspecific symptoms such as swelling, soreness, redness, and pruritus. Topical and oral steroids, as well as antihistamines, are used to treat subconjunctival hypersensitivity reactions. It has also been noted that posterior scleritis and the formation of episcleral nodules occur.
Conclusion
Tattooing cosmetically disfiguring corneal scars might be a beneficial therapeutic option for people for whom reconstructive surgical methods will either not result in functional improvement or entail the danger of phthisis. Aside from that, the increasing difficulty in wearing a printed contact lens or bulbar shell and the patient's apprehension about recurrent surgery may be significant.
Selecting the best modification for corneal tattooing among the several described is challenging. Over time, technological advancements have reduced the actual practice of corneal tattooing. Although technological developments have reduced the popularity of corneal tattooing, some people still do it. The mix of modern technologies and classic techniques may boost tattooing's appeal in the future.
