Tattoo for Corneal Scars
Corneal tattooing has been used for centuries to improve the cosmetic appearance of a blind eye with an unsightly leukoma. It has also been used occasionally in seeing eyes to reduce the glare from scars and to eliminate monocular diplopia in patients with large iridectomies, traumatic loss of iris, and congenital iris colobomas (Fig 13-9). For small iris defects, applying a marking pen to the cornea over the affected area can simulate the effect of tattooing. Although the effect is temporary, this allows patients to experience the procedure’s effect.
Different techniques may be used to create a tattoo. One involves applying a platinumion solution to the cornea. When this solution reacts with a second agent, a black precipitate is formed in the cornea, producing a dark deposit that can simulate a pupil. Another technique involves utilizing the standard methods used in skin tattooing: applying to the cornea a paste of colored pigment, either India ink or a metal oxide, and then using a hypodermic needle or angled blade to drive the pigment into the corneal stroma in the area that needs coverage. Multiple superficial punctures are made until enough pigment has been applied; multiple pigment colors can be used to give a more natural appearance. However, the method is time-consuming and often needs to be repeated if the pigment uptake is inadequate or the pigment migrates. Femtosecond laser–assisted anterior lamellar corneal staining/tattooing in the cosmetic treatment of leukocoria is under investigation.
Figure 13-9 Clinical photograph showing a corneal tattoo for a cosmetically displeasing inferior scar in a young woman.
(Courtesy of Robert W. Weisenthal, MD.)
Kim JH, Lee D, Hahn TW, Choi SK. New surgical strategy for corneal tattooing using a femtosecond laser. Cornea. 2009;28(1):80–84.
Rocher N, Hirst L, Renard G, Doat M, Bourges JL, Mancel E. Corneal tattooing: a series of 14 case studies. J Fr Ophtalmol. 2008;31(10):968–974.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.