Forget spooky looking contact lenses causing their share of problems and infections this Halloween; eyeball tattooing is now trending and its complications are terrifying eye care professionals year-round.

Eyeball tattooing involves injecting a colored ink between the two outermost layers of the eye. Multiple injections of the ink are needed to in order to change the whites of the eyes to a completely different color. Bright orange, purple, green, red and even jet black are just some of the hues partakers of this trend are choosing to don in order to permanently change their eyeball color from white to wacky.

As one can imagine, some pretty gruesome complications can arise due to mistakes made while administering these injections. Additionally, inflammation and infection can also crop up secondary to this procedure and can cause major, and possibly permanent, vision problems.

First let’s talk about the anatomy of the eye and how it makes these injections possible.

Dissecting the Anatomy

The sclera is what we think of as the “whites” of the eyes. However, many do not realize that there is another, clear thin membrane that covers the sclera called the conjunctiva. You can think of the conjunctiva almost as “saran wrap” encapsulating the sclera. Normally only blood vessels and serous fluid reside between these two layers so our eyes appear shiny and white but there are a few exceptions of other substances that can accumulate between them. Blood, in the case of a subconjunctival hemorrhage, melanin pigment, in the case of a birthmark or freckle, and bilirubin, in the case of jaundice, can all accumulate between the two layers of the eye and change the whites of the eyes to red, spotted brown or yellow respectively.

Credit: Cheryl G. Murphy

But consciously choosing to change the whites of the eyes to a frightful, fluorescent pink? A supernatural neon green? Or a bloodcurdling, fire-engine red?

“Cool!” you might say. “Why not?”

Well, there are a lot of reasons why not. The eyes are amazing organs but in some ways they are delicate and not as resilient as the skin when it comes to tattooing.

Pain, Perforation, Inflammation, Oh My!

Many things can go wrong with the process of eyeball tattooing. In the case of a young woman from Ottawa who wanted to change her scleral color to light purple, the body modification artist she chose made the mistake of not diluting the ink before he injected it. He also used the wrong sized needle. That led to complications including a tear in the conjunctival tissue which allowed the ink to slowly seep out. The woman suffered for weeks with eye pain and blurry, sometimes doubled, vision. She shared her story along with a picture of her crying a purple tear and it went viral. She hoped to educate others on complications that can occur from this procedure and wanted to warn them that if they are going to do it, they need to make sure the person performing it knows what they are doing.

Credit: Cheryl G. Murphy

Besides a rip in the conjunctiva, other mishaps while injecting can not only cause pain, but they can also perforate the globe (poke a hole in the eye), cause a traumatic cataract, instigate a retinal detachment or cause severe inflammatory responses inside of the eye such as endophthalmitis.

It is thought that in some cases, an inflammatory reaction in the eye may be brought on by a delayed hypersensitivity response that some individuals may have to the ink. Not only does the body recognize the ink as something foreign, the person may be allergic to a chemical that the ink contains such as cobalt, nickel, copper, chromium or iron. Believe it or not, skin tattoos (not just eyeball tattooing) have also been shown to cause an inflammatory response in the eye of certain highly allergic individuals. That means that when someone goes for a regular tattoo on their skin (nowhere near their eye), the dye on their skin may incite a specific type of inflammatory reaction in their eye called uveitis. Uveitis can cause eye pain, light sensitivity and blurry vision but it is temporary when treated properly with prescription eye drops given by an eye care professional.

In April 2017, an article published in the American Journal of Ophthalmology: Case Reports showcased other “short term complications of eyeball tattoos.” It highlighted the case studies of two people in Mexico who had the procedure performed and who suffered complications.

The first was a 26 year old male who was left with two severe inflammatory reactions in the eye after receiving an eyeball tattoo; orbital cellulitis and posterior scleritis. He had to be admitted to the hospital, given intravenous antibiotics as well as topical antibiotic eye drops. He was also put on a steroid medication to help reduce the inflammation. Weeks passed and eventually, most of his swelling resolved and his vision returned to 20/25 in the affected eye. However, the green ink used in his injections had seeped onto the skin of his lower outer eyelid and stained the skin there permanently green. One can guess that a green eyeball surrounded by green skin (although ghoulish looking) was not the look he had originally intended.


The second case involved a 17 year old man who had several tattoos on his skin. He presented with two nodules or “bumps” of orange ink on the white of his eye after trying to get his first eyeball tattoo. Apparently, the ink had infiltrated underneath the conjunctiva but had not spread out at the site after injection. The male was eerily left with two strange orange bumps on the whites of his eye. He was given steroid medication and topical antibiotics drops but did not return to the clinic for follow up treatment. Instead he left those who treated him haunted with the wonderment of what happened next.

Be Afraid, Be Very Afraid

Purple tears? Orange bumps? Ghoulish green skin? Not to mention the possibility of being left in perpetual darkness if you lose your sight? A nightmarish scenario that you do not want to put your peepers through. So beware, eyeball tattoo seekers. The process may contain more tricks than treats.