Inadvertent pigmentation of the limbus during cosmetic blepharopigmentation

To present a case of perilimbal pigmentation as a complication of cosmetic blepharopigmentation.

Interventional case report.

A 54-year-old white woman underwent bilateral upper and lower eyelid cosmetic blepharopigmentation. After the procedure, the patient noted a small area of black pigmentation of the surface of her right eye. Slit-lamp examination revealed perilimbal pigmentation involving the conjunctiva and the superficial cornea of the right eye. The affected conjunctiva was excised, and a diamond burr used to remove the underlying pigmented superficial cornea and sclera. The excised conjunctiva was analyzed by standard light microscopy. Hematoxylin and eosin-stained sections of the surgical specimen showed a thin ribbon of pigmentation just under the conjunctival epithelium without obvious inflammatory cell reaction around the extracellular pigment. The patient tolerated the surgical removal of the pigmentation without any complications and was pleased with the cosmetic result.

Possible complications of blepharopigmentation include pigment deposition into the conjunctiva and the superficial cornea and sclera as was seen in this case report. This case of inadvertent pigmentation did not cause any significant chronic inflammation, although acute and chronic inflammatory reactions of the conjunctiva and surrounding structures have been reported as complications after cosmetic blepharopigmentation. Surgical removal of the affected tissue is a treatment option and was successful in removing the pigment in this case.