Background: Hair dye ingestion is an attractive means of deliberate self harm because of its low cost and unrestricted availability and is common in rural south India. Patients present with compromised airway due to upper respiratory tract edema, facial and neck edema. Aim: To determine the criteria for managing airway by tracheostomy in patients with hair dye poisoning. Methods: This study was conducted in Tirunelveli medical college and patients with alleged history of consuming hair dye were included in study. Patients who mixed other poisons with hair dye were excluded from study. ENT examination to identify edema of oral cavity, pharynx, larynx and neck and facial edema was routinely performed. If the patient had edema with fall in SpO2 and breathing difficulty, tracheostomy was done. Results: The mean duration between consumption of hair dye to development of symptoms was 3.0 ±1.5 hours and the same to tracheostomy was 5± 2.2 hrs. Tracheostomy increased the need for hospitalization 16.4 ± 9.4 days. Patients had swallowing problems due to pharyngeal edema and tracheostomy further delayed the initiation of oral feeds 8.3±5.3 days. Conclusion: The amount of hair dye consumed and time of presentation to the hospital are an important risk factor for developing oropharyngeal edema, which in turn determines the risk of mortality.