A 26-year-old Mexican man presented with pain, photophobia, decreased visual acuity and eyelid edema in the right eye after undergoing a green eyeball tattoo in a tattoo parlor. Four days later symptomatology worsened and he sought medical care. The patient reported that the green pigment used in the injection was diluted with isopropyl alcohol, distilled water and glycerin.
A clinical diagnosis of orbital cellulitis and posterior scleritis of the right eye was made. The patient was admitted for hospitalization. Intravenous antibiotic treatment (ceftriaxone and clindamycin) and topical antibiotic (moxifloxacin) were started. Two days later, oral prednisone was initiated. A right tarsorrhaphy was performed due to conjunctival exposure and after three days the sutures were removed, resulting in clinical improvement.
The patient completed 7 days of oral antibiotic treatment and prednisone was slowly tapered for 30 days.
Fifteen days after starting treatment, proptosis, restriction of ocular movements and chemosis resolved, choroidal detachment disappeared and visual acuity improved. The right lower eyelid developed a green pigmentation.
Eyeball tattoos are done by non-ophthalmic trained personnel, which increases the risk of serious ocular complications like globe penetration and endophthalmitis.
Nevertheless, long-term effects on the eyes and vision are uncertain, but in the worst case scenario could include the loss of vision or the eye. Regulations prohibiting the practice of these procedures are required, because despite warnings of multiple health risks, more people are looking to get this procedure nowadays.
Credit: American Journal of Ophthalmology Case Reports Volume