Two cases of pen ink scleral tattoos and a brief review of the literature

Abstract

Purpose Scleral tattooing, also known as episcleral, subconjunctival, or simply eyeball tattooing, is a relatively new form of extreme body modification that first emerged in 2007. There are few reports of the management of these tattoos in the medical literature, and we aim to increase the body of knowledge surrounding this rare and potentially dangerous practice. Observations We present two new cases of improvised scleral tattooing, both performed in prison using pen ink and insulin needles, and both with minimal complications and managed with topical medications. A brief review of the literature is included which details the dangers of scleral tattooing. Conclusions and importance We discuss management of complications for this new, previously unreported method of scleral tattooing using pen ink. Ophthalmologists should be aware of the presentation, possible complications, and management of these cases.

Scleral tattoo-induced sarcoid reaction

“…Current literature suggests that cases without inadvertent globe penetration tend to be managed with topical treatment, 3 but this report highlights that certain complications may require systemic medical management. Management of this complication may require long-term immunosuppressive therapy.…”

“…globe puncture with intravitreal dye injection, 1 immediate orbital cellulitis, posterior scleritis, and subepiscleral nodules. 2,3 This is the first case, to our knowledge, exploring a delayed and possibly long-term complication of scleral tattooing with systemic implications.…”

“…Management of this complication may require long-term immunosuppressive therapy. As Rohl et al 3 noted previously, excision of ink-containing tissue would pose a unique challenge if reactions persist. This is relevant in this case given the likelihood of such persistence and long-term immunosuppressive therapy for patients with this complication.…”