Injecting permanent pigment into the white part of the eye, known as the sclera, is an extreme form of body modification called a scleral tattoo. This procedure bypasses established medical and safety protocols, making it highly controversial and medically unapproved. The ink is placed between the thin, transparent outer membrane (the conjunctiva) and the fibrous sclera, where it is intended to spread and permanently color the eye. Because the eye is a delicate sensory organ, the procedure carries a high risk of severe complications, and any subsequent attempt at removal is complex and dangerous.
Feasibility of Scleral Tattoo Removal
The anatomical constraints of the eye make scleral tattoo removal different from removing ink from skin. The sclera, the eye’s protective outer wall, is less than one millimeter thick in certain areas, sitting directly atop the light-sensitive retina and the vascular choroid layer. Unlike skin tattoos where ink is held in the dermis, scleral ink is injected into a subconjunctival space, dispersing in an unpredictable, unconfined manner. This lack of distinct encapsulation means ink particles are scattered across a wide, delicate area, making precise targeting for removal virtually impossible.
There are no standardized, safe, or FDA-approved medical protocols for removal. The goal of removal is often a desperate attempt to mitigate progressive, vision-threatening complications, not merely aesthetic improvement. Success in reversing the procedure is rare, and the outcome is unpredictable, often resulting in minimal improvement. Professionals must first perform an extensive evaluation to assess the depth and spread of the pigment, which determines the limited feasibility of any procedure.
Experimental Removal Approaches
The approaches explored to address scleral tattoo regret are limited, experimental, and carry significant risks.
Laser Removal
Traditional laser tattoo removal, which uses intense light pulses to shatter ink particles in the skin, is strongly contraindicated in the eye. The energy from Q-switched or picosecond lasers risks passing through the translucent sclera, causing thermal damage to the internal, light-gathering structures of the eye. Using a laser directly on the sclera could also cause irreversible damage to the thin tissue, which is not designed to withstand such focused energy.
Surgical Excision
Surgical excision involves the physical removal of the pigmented tissue, which is an invasive measure. In cases of severe inflammation or the formation of an episcleral nodule (a lump of immune cells and ink), a surgeon may attempt to remove the affected portion of the conjunctiva. Removing a large, tattooed area of the sclera requires complex grafting and carries a high risk of permanently compromising the structural integrity of the globe. Replacing the scleral tissue is a procedure reserved only for severe trauma or disease.
Subconjunctival Flushing
Subconjunctival washes or flushing have been attempted, primarily to manage acute complications rather than as an effective removal technique. This process involves trying to flush the ink out of the subconjunctival space using a sterile solution. This method is often unsuccessful because the ink is deeply embedded or scattered, and the procedure itself can introduce infection or further trauma. In severe instances where ink has migrated into the anterior chamber or the vitreous body, surgeons have performed complex procedures like an anterior chamber washout or a pars plana vitrectomy to remove the toxic, migrated pigment.
Irreversible Outcomes of Attempted Removal
The consequences of a failed scleral tattoo procedure or an unsuccessful removal attempt are often permanent. One immediate outcome is irreversible vision loss, ranging from decreased visual acuity to complete blindness. This loss can be caused by glaucoma, where increased pressure damages the optic nerve fibers, or by a retinal detachment resulting from the initial trauma or subsequent surgical intervention.
The foreign ink can trigger a chronic inflammatory response, such as uveitis or endophthalmitis, a severe internal eye infection that is difficult to treat. Chronic inflammation often leads to persistent pain, extreme light sensitivity, and the constant feeling of a foreign body. In the most severe cases, the eye may suffer globe perforation, causing the eye to shrink and become non-functional, a condition called phthisis bulbi. When pain becomes intractable or the eye is non-salvageable due to infection or structural damage, the final procedure is enucleation, the surgical removal of the entire eyeball. Histopathological studies on enucleated eyes confirm the presence of toxic ink particles deep within the inner retina and the corneal endothelium, underscoring the irreversible nature of the damage.