Inadvertent corneal pigmentation following cosmetic blepharopigmentation

PURPOSE: To present a case of inadvertent corneal pigmentation as a complication of cosmetic eyelid tattooing. OBSERVATIONS: A 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 IMPORTANCE: While 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.