An injection sclera, known as a scleral or eyeball tattoo, is a cosmetic form of extreme body modification. The procedure involves permanently coloring the white part of the eye by introducing pigment directly into the eyeball, which is different from traditional skin tattooing. This practice is performed for aesthetic reasons, altering a person’s appearance by changing the color of their eyes to shades like black, blue, or purple.
Anatomy and Function of the Sclera
The sclera is the white, tough outer layer of the eyeball, forming over 80 percent of the eye’s surface area. It extends from the clear cornea at the front to the optic nerve at the back. This layer is composed of densely packed, crisscrossing collagen and elastic fibers, which give it both strength and flexibility. The sclera’s primary purpose is to act as a protective shell, maintaining the eyeball’s shape and shielding the delicate structures inside from injury.
This protective wall provides a sturdy anchor for the muscles that control eye movement. The sclera itself has a very limited blood supply and is not designed to absorb or hold foreign substances like ink. It is covered by a thin, clear membrane called the conjunctiva, which helps lubricate the eye. The sclera’s dense and fibrous nature makes the introduction of ink a significant biological challenge.
The Scleral Injection Procedure
The process of creating an eyeball tattoo is fundamentally different from skin tattooing and is not a standardized medical or artistic practice. It involves using a fine needle to inject a small amount of liquid ink into the eye. The goal is to place the pigment into the potential space between the sclera and the overlying conjunctiva. Once injected, the ink is intended to spread across the surface of the sclera, permanently staining the white of the eye.
This procedure is exceptionally high-risk because the sclera is less than a millimeter thick in some areas. There is no formal training, licensing, or certification for performing scleral tattoos, meaning practitioners often lack a thorough understanding of ocular anatomy. An injection that is too deep can easily perforate the globe of the eye, while an injection that is too shallow can place the ink in the wrong tissue layer. The type and sterility of the ink used are also unregulated.
Immediate and Long-Term Health Consequences
The health consequences of scleral tattooing can be immediate, with complications arising during the procedure or years later. Immediate issues include intense pain, infection from unsterile ink or needles, and perforation of the eyeball. If the needle penetrates the sclera, it can inject ink directly into the vitreous humor, leading to severe damage and bacterial contamination. Over-injection of ink can cause a sudden increase in intraocular pressure, which damages the optic nerve.
In the weeks and months following the procedure, other serious problems can develop. The injected ink can migrate, causing blotchy patterns or moving to other parts of the eye where it can obstruct vision. Chronic and painful inflammation is a frequent complication, such as uveitis or scleritis. Many individuals develop severe light sensitivity (photophobia), and some experience retinal detachment.
The long-term outlook includes a high potential for irreversible vision loss. Ink particles can clog the eye’s natural drainage channels, leading to secondary glaucoma that can destroy the optic nerve over time. The procedure is also linked to the early formation of cataracts. A severe risk is sympathetic ophthalmia, an autoimmune response where the body’s immune system attacks both the tattooed and the healthy eye. In cases of uncontrollable infection or pain, the only medical option may be enucleation, the complete surgical removal of the eye.
Medical Management of Complications
Medical intervention for complications from a scleral tattoo focuses on managing symptoms and controlling damage. The procedure is considered permanent, as there is no safe or effective method to remove the ink from the sclera once it has been injected. Attempts to treat the resulting conditions are often complex and prolonged, requiring care from an ophthalmologist.
Treatment strategies are tailored to the specific complication. Severe inflammation like uveitis or scleritis may be managed with high-dose steroids to suppress the immune response. Infections, such as endophthalmitis, require aggressive treatment with injected antibiotics. If the procedure causes a retinal detachment, surgery is necessary to reattach the tissue and prevent permanent blindness.
For conditions like secondary glaucoma, patients may need lifelong treatment with medicated eye drops to lower intraocular pressure, and surgical procedures may be required to improve fluid drainage. When these interventions fail and the eye is left blind, in chronic pain, or poses a risk to the other eye, enucleation becomes the final medical resort.