Scleral tattooing is a body modification procedure that involves coloring the white part of the eye (the sclera). While it is physically possible to inject pigment into the eye’s outer layers, this non-medical process is highly controversial and is not supported by ophthalmologists or licensed healthcare providers. The technique differs significantly from traditional skin tattooing and is performed solely for cosmetic purposes, posing serious, often permanent, risks to vision.
The Anatomy and Procedure of Scleral Tattooing
Scleral tattooing targets the sclera, the tough, white, fibrous outer layer of the eyeball that provides structure and protection. The sclera is covered by the conjunctiva, a thin, clear membrane that also lines the inside of the eyelids. The goal of this cosmetic procedure is to permanently color the white part of the eye.
The methodology does not use a typical tattoo machine or the repeated puncturing of traditional tattooing. Instead, the process involves injecting specialized ink with a very fine needle directly into the space beneath the conjunctiva and onto the sclera. This is usually done in multiple small injections, allowing the pigment to spread and diffuse across the sclera, coloring the entire visible white area. The inks used are typically water-based tattoo pigments that are not approved or tested for use within the delicate tissues of the eye.
This procedure must be clearly differentiated from corneal tattooing, a rare medical technique sometimes used by ophthalmologists to camouflage scar tissue on the cornea. Scleral tattooing, in contrast, is performed for purely aesthetic reasons by individuals who typically lack formal medical training in ocular anatomy. The placement of the ink must be precise, as the sclera itself is less than a millimeter thick in some areas, making it extremely vulnerable to perforation and damage.
Immediate and Lasting Health Implications
The delicate nature of the eye and the non-sterile, non-medical environment lead to a high potential for severe complications. Acute issues that can arise immediately after the procedure include severe pain, significant inflammation, and swelling of the conjunctiva and surrounding orbital tissues. The injection site is a direct portal for microbes, significantly increasing the risk of serious infections such as endophthalmitis, which is inflammation inside the eyeball that can rapidly lead to total vision loss.
A major risk is the potential for the needle to be inserted too deeply, injecting pigment into the inner parts of the eye, such as the vitreous cavity or onto the retina. This can cause immediate retinal trauma, leading to permanent or partial vision loss. The introduction of foreign pigment can also trigger a foreign body reaction, resulting in the formation of granulomas, which are masses of inflammatory tissue that may require surgical removal.
Chronic and long-lasting problems are common because the eye lacks the robust blood supply necessary to clear foreign materials and heal quickly. The ink can migrate, causing staining of surrounding tissues like the iris, which can impair vision by changing how light enters the eye. Inflammation and swelling can lead to an increase in intraocular pressure, contributing to the development of glaucoma, which damages the optic nerve and causes irreversible vision loss. The American Academy of Ophthalmology (AAO) warns that complications have led to cases requiring the surgical removal of the entire eye (enucleation) due to intractable pain and infection.
The Regulatory Landscape and Professional Standards
The severe health risks associated with scleral tattooing have prompted legal and professional reactions across different regions. Regulation of the practice is inconsistent, resulting in a patchwork legal landscape. Several jurisdictions have banned the procedure entirely, recognizing the danger it poses to public health.
In the United States, states including Oklahoma, Indiana, and Nebraska have outlawed scleral tattooing. Internationally, Canadian provinces like Ontario and Saskatchewan, as well as Australia, have banned the procedure unless performed by a medical practitioner for a medical reason. These bans are a direct response to the high number of complications and the lack of safety standards inherent in the procedure.
The professional medical community maintains a strong consensus against cosmetic scleral tattooing. Ophthalmologists and licensed medical professionals do not perform this procedure for aesthetic purposes. Medical bodies, including the Royal Australian and New Zealand College of Ophthalmologists, describe it as an “extremely dangerous, irreversible procedure.” The absence of formal training, licensing, or certification for individuals performing scleral tattooing contributes to the high complication rate, as the procedure is often done without proper knowledge of ocular anatomy or sterile techniques.