Scleral Tattooing Complications: Surgical Management of Granulomas in a Cosmetic Procedure

To report the surgical management and outcomes of a patient with granulomatous inflammation following scleral tattooing, emphasizing the associated risks and clinical implications.

A 26-year-old woman with a history of multiple body modifications, including scleral tattooing, presented with bilateral ocular pain and discomfort. Clinical examination revealed corneal dellen and subconjunctival granulomas. The patient underwent surgical excision of the granulomas, with efforts to preserve the black conjunctival pigmentation. Histopathological analysis was performed on the excised tissue. The patient's visual acuity and ocular condition were monitored for 12 months postoperatively.

Preoperative best-corrected visual acuity was 20/50 in the right eye and 20/60 in the left. Surgical excision of the granulomas was successfully performed, resulting in symptomatic relief and preservation of the black scleral coloration. Histopathological analysis confirmed the presence of exogenous pigment without hemosiderin or melanin deposits. Twelve months after surgery, the patient maintained a best-corrected visual acuity of 20/20 in both eyes, with no recurrence of granulomas or additional complications.

This case highlights the serious risks associated with scleral tattooing, including granulomatous reactions and corneal complications. Surgical intervention effectively addressed the ocular issues while preserving the desired cosmetic outcome. Greater public awareness and stronger regulations are critical to prevent such complications, and to prepare ophthalmologists for managing cases of scleral tattooing-related injuries.