Eyeball tattoos with short-term complications.
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Eyeball tattoos are a relatively new extreme body modification.This procedure, which is performed for cosmetic purposes, involves injecting some type of pigment directly under the bulbar con-junctiva with a needle. It can be very dangerous for the health of patients if the procedure is done without authorized guidance.

Case instance
A 26-year-old Mexican man presented with pain, photophobia,decreased visual acuity and eyelid edema in the right eye 2 h after undergoing a green eyeball tattoo and a subconjunctival penicillin injection in a tattoo parlor. Four days later symptomatology worsened and he sought medical care. His past medical history was positive for penicillin allergy, smoking and using recreational drugs. He also had multiple tattoos.

At admittance best corrected visual acuity (BCVA) was 20/100 inthe right eye and 20/25 in the left eye. Intraocular pressure (IOP)was 16 and 14 mmHg, respectively. The right eye showed axial proptosis, restriction of ocular movements, significant eyelid edema, green conjunctival pigmentation, superior subconjunctival hemorrhage and diffuse chemosis . B-scan showed a T-sign and an annular choroidal detachment from the equator to periphery. Retinal optical coherence tomography (OCT) confirmed the presence of macular folds in the right eye.The patient was admitted for hospitalization.

Intravenous antibiotic treatment and topical antibiotic (moxifloxacin) were started. Two days later,oral prednisone was initiated. A right tarsorrhaphy was performed due to conjunctival exposure and after three days the sutures were removed, resulting in clinical improvement.The patient completed 7 days of oral antibiotic treatment and prednisone was slowly tapered for 30 days.Fifteen days after starting treatment, proptosis, restriction of ocular movements and chemosis resolved, choroidal detachment disappeared and visual acuity improved to 20/25 in the right eye

Conclusively,eyeball tattoos are done by non-ophthalmic trained personnel,which increases the risk of serious ocular complications like globe penetration and endophthalmitis. Nevertheless, long-term effects on the eyes and vision are uncertain, but in the worst case scenario could include the loss of vision or the eye.

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