Scleral tattooing, commonly known as eyeball tattooing, is a cosmetic procedure that permanently colors the white part of the eye (the sclera). This modification is achieved by injecting ink pigment beneath the conjunctiva, the thin protective membrane covering the sclera, allowing the ink to spread and stain the tissue. Despite its growing popularity as an extreme form of body modification, the practice is not performed by trained medical professionals and carries a high risk of severe, life-altering complications. Medical experts universally caution against its use, as the procedure lacks scientific or ophthalmic backing.
The Procedure and Immediate Complications
The process involves multiple needle injections to deposit non-ophthalmic grade ink into the subconjunctival space, just above the sclera. Unlike standard skin tattoos, this procedure introduces foreign material into the sensitive structure of the eye. The inks used are typically commercial tattoo inks, which are not sterilized or formulated for intraocular use and may contain unapproved pigments or heavy metals.
The immediate complications are often acute and painful. Patients commonly experience severe eye pain, substantial swelling (edema), and intense sensitivity to light (photophobia). Subconjunctival hemorrhage, or bleeding at the injection site, frequently causes the ink to migrate or clump shortly after injection.
Introducing non-sterile ink and equipment also presents a high risk of acute infection, such as conjunctivitis. Allergic reactions to the ink itself are also common. Even if the ink is successfully placed, the trauma of the injection and the presence of foreign material trigger an immediate inflammatory response from the body.
Permanent Damage to Vision and Eye Structure
The potential for irreversible damage is high due to the procedure’s technical difficulty. Since the sclera is less than one millimeter thick, a slight error in needle depth can cause globe perforation. This allows ink to be injected into the eye’s interior structures, such as the vitreous humor or anterior chamber. This internal contamination causes severe damage, including retinal necrosis and endophthalmitis, a severe infection inside the eye.
The ink acts as a toxic irritant, triggering chronic inflammation known as uveitis or scleritis. Uveitis, the inflammation of the middle layer of the eye, can lead to scar tissue formation and the breakdown of normal eye function. Ink particles or swelling can also block the eye’s natural drainage pathways, causing a spike in intraocular pressure that leads to secondary glaucoma.
Globe puncture can also cause a localized retinal detachment, where the light-sensitive tissue pulls away from its supportive layer. This detachment or the chronic inflammation can lead to permanent vision loss or total blindness. The foreign material may also trigger granuloma formation, which are masses of inflammatory tissue that cause structural distortion and pain.
Medical and Surgical Interventions
When complications arise, the medical response is aggressive and aims at preserving the globe, not the tattoo. Initial management of severe inflammation, such as uveitis, involves long-term, high-dose topical and sometimes systemic corticosteroids. These suppress the body’s immune reaction to the ink, but steroid use carries risks and may not control the underlying inflammation.
If the ink has been injected deep into the eye, immediate surgical intervention is required. This often involves specialized procedures like an anterior chamber washout to remove pigment from the front of the eye. For severe injuries, such as retinal detachment or ink contamination in the back of the eye, a pars plana vitrectomy is performed to remove the vitreous gel and toxic ink particles.
Despite surgical efforts, the structural damage is frequently irreparable. The most alarming intervention is enucleation, the complete surgical removal of the eye. This becomes necessary when infection, uncontrolled pain, or chronic inflammation threaten the patient’s health or when the eye is functionally non-viable. Since the ink is deeply embedded, the cosmetic modification is permanent and non-reversible; standard tattoo removal techniques cannot be safely applied.
Unregulated Practice and Expert Warnings
A fundamental issue is the lack of regulation, professional standards, and medical oversight. The procedure is almost exclusively performed by non-medical practitioners who lack formal training in ophthalmology or sterile ophthalmic techniques. This absence of expertise means the tattoo is often performed without the precision necessary to avoid catastrophic damage to the eye’s delicate layers.
Major medical organizations have issued strong warnings against the practice. The American Academy of Ophthalmology and the Royal Australian and New Zealand College of Ophthalmologists advise against cosmetic eyeball tattooing. These bodies emphasize that the procedure was not developed by a physician and has not been medically or scientifically studied for safety.
The inks are a significant concern, as the U.S. Food and Drug Administration (FDA) has not approved any pigments for injection into the eye. While the FDA regulates tattoo inks for skin application, they are not tested for safety when injected into ocular tissue. Due to the documented severity of complications, several jurisdictions, including the Canadian provinces of Ontario and Saskatchewan, and American states like Oklahoma and Indiana, have officially outlawed the practice.