Inadvertent corneal pigmentation following cosmetic blepharopigmentation

by Science Editor

This case highlights the importance of choosing an experienced, well trained cosmetic tattooist for your procedures.

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Inadvertent corneal pigmentation following cosmetic blepharopigmentation.

Abstract: The Authors: present a case of inadvertent corneal pigmentation as a complication of cosmetic eyelid tattooing.

A 63 year old woman presented with left eye redness and irritation 3 days after undergoing permanent eyeliner tattooing of her upper and lower eyelids. On ocular examination a black pigmentation of the nasal cornea in her left eye was observed, with associated conjunctival injection. Initial slit lamp attempts of pigment removal were unsuccessful.
Industry Significance Rating:

High - Industry alert, report has major implications related to health and safety.


American Journal of Ophthalmology Case Reports. 2018 Sep 5;12:52-54. doi: 10.1016/j.ajoc.2018.09.002.

Authors: Hila Goldberg, Yoav Berger, Iris Ben Bassat, Irina Barequet.
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The authors present a well described case with high resolution sequential photographs prior to and subsequent to treatment.

This case highlights that although eyeliner tattooing has become a relatively routine procedure provided by many cosmetic tattoo technicians there are potential risks particularly if due care is not exercised. Inadvertent tattooing of the eye surface may occur during an eyeliner procedure due to a variety of reasons such as;

  • Unexpected sudden movement of the client

  • Operator carelessness

  • Full thickness lid penetration - excessive needle depth/failure to measure needle depth

  • Tattooing the lid mucosa

  • Tattooing with eyelids open

  • Use of high impact equipment not specifically designed for micropigmentation

  • Use of outdated/inaccurate equipment e.g. older style rotary pen devices

The skin of the eyelid is extremely thin (the thinnest of any region on the body) particularly near the lid margins, cosmetic tattoo technicians need adequate training in anatomy and physiology of the eyelids to be able to adequately comprehend the risks associated with eyeliner tattooing. Blepharospasm of the client during the procedure, tattooing of the mucosa, or changes to needle angle could potentially result in inadvertent full thickens penetration of the lid.


Comprehensive training by those certified in micropigmentation & training and assessment, ideally training programs should also be supervised by a registered health professional for all medical tattoo and high risk makeup tattoo services such as eyeliner tattooing, as well as the following general objectives for risk minimisation;

  • Selection of high quality devices specifically manufactured for micropigmentation services.

  • Avoid tattooing on or near the lid mucosa.

  • Needle depth should always be carefully measured.

  • Clear understanding of the effect that changes to needle insertion geometry have on actual needle depth.


Scientific Report,  eyeliner tattooing, eye, cornea, stromal pigmentation


The Education Team here at keeps a close eye on the scientific and medical literature for new publications relating to cosmetic and medical tattooing that may be of interest to customers. The intent is to alert industry members to important publications within the literature to expand the knowledge base particularly in relation to high impact reports.

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