Scleral tattooing, also known as eyeball tattooing, is an extreme cosmetic modification that permanently colors the white part of the eye (the sclera). While possible, medical professionals strongly advise against this purely aesthetic practice due to its extreme dangers. Given the delicate anatomy of the eye, the procedure carries severe and often irreversible health risks. It is a niche practice lacking medical approval or standardized safety protocol.
How Scleral Tattooing is Performed
The procedure for scleral tattooing uses an injection method known as a subconjunctival injection. A fine needle, often a syringe, is used to introduce the pigment just beneath the conjunctiva, the thin, clear membrane covering the sclera.
The goal is to deposit the ink into the space between the conjunctiva and the underlying sclera, allowing the pigment to spread and stain the white surface. The injection is typically performed in multiple small drops around the eye, and the pigment then diffuses across the scleral tissue to achieve a uniform color. The anatomical location is extremely sensitive, as the sclera itself is less than one millimeter thick in some areas.
The ink used is usually a colored pigment, sometimes a diluted version of traditional tattoo ink or a proprietary mix, which is not regulated for ocular use. There is a complete lack of standardization regarding the tools, the technique, and the composition of the dyes used by non-medical practitioners. Unlike medical procedures, there is no formal training or certification process for individuals performing this risky modification.
Severe Health Risks and Complications
The nature of scleral tattooing introduces foreign material into a delicate, sterile environment, leading to severe complications. One of the most immediate and dangerous risks is endophthalmitis, a serious infection inside the eyeball that can rapidly lead to permanent vision loss. The procedure also carries a significant risk of chronic inflammation, which can manifest as uveitis, causing pain and light sensitivity (photophobia).
Incorrect needle placement is a constant threat, as a slight error can penetrate the globe, leading to catastrophic internal damage. This can result in retinal detachment, where the light-sensitive tissue at the back of the eye pulls away, causing partial or total blindness. The injection of ink can also increase intraocular pressure, which damages the optic nerve and may lead to glaucoma.
The injected pigment can migrate to other internal structures, including the retina, causing blurred vision and permanent damage. The inks are not designed for ocular use and may contain heavy metals that trigger toxic or allergic reactions. In the most severe cases of intractable pain, infection, or uncontrolled inflammation, the eye may need to be removed entirely (enucleation). Once injected, the ink is nearly impossible to remove without causing further damage.
Medical and Regulatory Opposition
The professional medical community is unified in its opposition to cosmetic scleral tattooing, considering it an extremely dangerous practice. Major organizations, such as the American Academy of Ophthalmology and the Royal Australian and New Zealand College of Ophthalmologists, have issued strong warnings against the procedure. Their condemnation is based on the high probability of severe, vision-threatening risks due to the lack of surgical precision and sterile conditions.
Medical professionals note that permanent coloration of the sclera can mask early signs of systemic diseases, such as jaundice, which is indicated by a yellowing of the whites of the eyes. The procedure is typically performed by untrained body modification artists who lack the necessary anatomical knowledge and sterile environment required for any intraocular procedure. This lack of oversight and medical accountability significantly increases the risk profile.
In response to the documented instances of harm, several jurisdictions have taken regulatory action to prohibit the practice. Scleral tattooing has been outlawed or heavily restricted in various states in the United States, including Oklahoma and Indiana, and in Canadian provinces like Ontario. These governmental and medical stances emphasize that the procedure is not a legitimate cosmetic treatment but a public health hazard.