Purpose

To evaluate the long-term outcomes, complications, and material choices of
corneal tattooing over a four-decade period at a tertiary care hospital.
Design: Retrospective cohort study.
Participants: A retrospective review was conducted of 303 eyes that underwent
corneal tattooing at King Khaled Eye Specialist Hospital (KKESH) between 1984 and
2024.

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Methods

Patient demographics, indications, pigment types, complications, and
satisfaction outcomes were analyzed. Procedures were performed using either
platinum chloride or Indian ink. Statistical analyses were conducted using the Student t
test and χ² test, with significance set at p < 0.05.

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Results

Of the 1,400 tattooed eyes, 303 were randomly selected. The mean age was
32.3 ± 17.1 years, and 178 patients (58.8%) were male. The most common indication
was white corneal opacity in eyes with no light perception (29.8%). Complications
occurred in 20 eyes (6.6%), most commonly persistent epithelial defects (5.9%),
followed by microbial keratitis (0.7%) and corneal perforation (1.0%). Complications
were significantly more frequent with platinum chloride ink (23.1%) than with Indian ink
(5.4%) (P = 0.02). The median interval between primary and repeat tattooing was 43
months (range: 0–276 months). Retattooing was required in 33% of cases, but patient
satisfaction remained high at 80.86%. Younger patients sought intervention earlier than
older patients.

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Conclusion

Corneal tattooing is a safe and effective cosmetic procedure for
disfiguring corneal opacities, with high long-term patient satisfaction. Indian ink
demonstrated a superior safety profile compared with platinum chloride. This study
provides evidence supporting corneal tattooing as a viable alternative to more invasive
procedures in carefully selected cases.

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Additional Authors

First name	Last name	Base Hospital / Institution
Ashwaq	Asiri	king khalid university
Aishah	Alaidan	King Khaled Eye Specialist Hospital
Abdulrahman	Alfarhan	King Khaled Eye Specialist Hospital
Nouf	Alqurashi	King Khaled Eye Specialist Hospital
Halah	Bin Helayel	King Khaled Eye Specialist Hospital
Hailah	al Hussain	King Khaled Eye Specialist Hospital
Osama	Alshike	King Khaled Eye Specialist Hospital

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