Inadvertent corneal pigmentation following cosmetic blepharopigmentation

Abstract

PurposeTo present a case of inadvertent corneal pigmentation as a complication of cosmetic eyelid tattooing.ObservationsA 63 year old woman presented with left eye redness and irritation 3 days after undergoing permanent eyeliner tattooing of her upper and lower eyelids. On ocular examination a black pigmentation of the nasal cornea in her left eye was observed, with associated conjunctival injection. Initial slit lamp attempts of pigment removal were unsuccessful. A surgical attempt to scrape the pigment in the stroma was only partially successful due to the penetration of pigment particles in between stromal lamellae. Microanalysis spectroscopy was performed on a specimen of pigment taken from the eyelashes in order to attain the chemical properties of the material and assist with further therapeutic strategy. The analysis revealed an organic inert nature of the material (mostly carbon and oxygen) and ruled out presence of dangerous components such as copper and lead. Due to minimal inflammatory reaction and the non-central location of the corneal pigmentation, the patient remained under close observation, treated with lubrication and no further interventions, until complete resolution by 6 weeks.Conclusions and importanceWhile the procedure of cosmetic blepharopigmentation is considered relatively safe, it bares many possible complications, ranging from mild dermal irritation to vision-threatening conditions. Our case of inadvertent keratopigmentation demonstrates the potential dangers of this procedure, and the importance of medical supervision and intervention in cases of complications. Vision preservation in this case was enabled by the midperipheral location of the pigment penetration.

A rapid review of physical health risks associated with special procedures (tattooing, body piercing, acupuncture, electrolysis)

“…Across the 37 cases presented in 31 case reports, the clinical presentations commonly reported after following the application of semi-permanent make-up are reported in Table 1 and include erythema or redness (Akoh et al 2021, Bashinskaya et al 2022, Gilhooley et al 2020, Goldberg et al 2018, Maier et al 2015, Mirzaei et al 2017, Naeini et al 2017, Sano et al 2021, Suleman et al 2023, Tittelbach et al 2018, Vera et al 2018); oedema or swelling (Akoh et al 2021, Gilhooley et al 2020, Lahouel et al 2022, Sano et al 2021, Soltany et al 2023), pain (Motoki et al 2020) and pruritus (Abtahi-Naeini et al 2019, Ibraheim et al 2023, Lahouel et al 2022, Motoki et al 2020, Tittelbach et al 2018, Valbuena et al 2017, Vera et al 2018).…”

“…The non-microbiological adverse reactions that have been described in the context of semi-permanent make-up included 25 cases (across 19 case reports) of sarcoidosis-related reactions (Bashinskaya et al 2022, Bombonato et al 2015, Ebrahimiadib et al 2021, Gilhooley et al 2020, Hirai et al 2022, Huisman et al 2019, Ibraheim et al 2023, Iwayama et al 2017, Mirzaei et al 2017, Naeini et al 2017, Nie et al 2022, Tukenmez Demirci et al 2016, Valbuena et al 2017, Vera et al 2018, Tittelbach et al 2018); 17 cases of granulomatous reactions, including papules (Bashinskaya et al 2022, Ebrahimiadib et al 2021, Hinojosa et al 2017, Hirai et al 2022, Huisman et al 2019, Ibraheim et al 2023, Iwayama et al 2017, Leight-Dunn et al 2022, Maier et al 2015, Naeini et al 2017, Nie et al 2022, Suleman et al 2023, Sun & Lao 2023, Tittelbach et al 2018, Tukenmez Demirci et al 2016, Valbuena et al 2017); three cases of allergic reactions (Lahouel et al 2022, Ibraheim et al 2023, Motoki et al 2020), 19 cases of skin-related adverse reactions (Abtahi-Naeini et al 2019, Akoh et al 2021, Bashinskaya et al 2022, Ebrahimiadib et al 2021, Gilhooley et al 2020, Hinojosa et al 2017, Goldberg et al 2018, Hirai et al 2022, Maier et al 2015, Mirzaei et al 2017, Naeini et al 2017, Marcelino et al 2021, Navarro-Triviño et al 2021, Nie et al 2022, Sano et al 2021, Suleman et al 2023, Tierney & Kavanagh 2021, Tittelbach et al 2018, Vera et al 2018) and five cases of eye-related adverse reactions and other adverse reactions (Sano et al 2021, Goldberg et al 2018, Hinojosa et al 2017, Soltany et al 2023, Navarro-Triviño et al 2021).…”

“…A number of skin-related adverse effects were described and these include crusting (Akoh et al 2021, Hinojosa et al 2017, Sano et al 2021, Suleman et al 2023), cutaneous lymphoid hyperplasia (Navarro-Triviño et al 2021); hyperpigmentation (Abtahi-Naeini et al 2019, Akoh et al 2021), hyperplasia (Marcelino et al 2021), induration (Maier et al 2015), irritation (Goldberg et al 2018), lichenoid tattoo reactions (Abtahi-Naeini et al 2019), pustules (Akoh et al 2021), rash (Hirai et al 2022, Nie et al 2022, Suleman et al 2023), scaling (Ebrahimiadib et al 2021, Maier et al 2015, Tittelbach et al 2018), vitiligo arising from the koebnerisation effect of microblading (Tierney & Kavanagh 2021).…”

“…Seven case reports achieved the highest rating of eight out of eight on the relevant critical appraisal checklist (Akoh et al 2021, Gilhooley et al 2020, Goldberg et al 2018, Hinojosa et al 2017, Leight-Dunn et al 2022, Mirzaei et al 2017, Soltany et al 2023, Sun & Lao 2023.…”

Cosmética ocular: generalidades e implicaciones médicas

“…La alteración de la función de las glándulas de Meibomio lleva a la disminución del tiempo de ruptura de la película lagrimal, factor predisponente para el desarrollo de un síndrome de ojo seco. Durante el procedimiento se manipula piel muy delgada, por lo que existe el riesgo de pigmentación limbar o corneal, punción accidental o perforación del globo ocular 55,63 .…”