A growing number of people are opting for a permanent way to change their eye colour through a surgical procedure known as Keratopigmentation (KTP).
Also called eye tattoos, Keratopigmentation involves depositing coloured pigments directly into the cornea of the eye to alter its appearance.
Though videos of the eye colouring technique have gone viral on social media, some experts warn that the potential health risks involved require more research as Keratopigmentation begins to move from an emerging trend to a mainstream procedure.
What is Keratopigmentation?
“It is a procedure where certain dyes/bio-pigments are injected into the cornea (the front and transparent part of the eye) to change the colour,” Dr. Mandeep Lamba, Specialist Ophthalmologist and Head of Retina Services, Prime Hospital.
Dr. Lamba explained that this process was initially used to cosmetically treat corneal opacities due to certain diseases or injury, causing the cornea to become white, making it unappealing.
“Currently it has been used in conjugation with a laser to change the colour of the peripheral cornea, again for cosmetic purpose,” he said.
Also known as corneal tattooing, Keratopigmentation has been used for centuries, according to Dr. Anjana Karunakaran, Specialist Ophthalmologist at Medeor Hospital, Dubai.
“KTP has emerged as a therapeutic approach for addressing symptomatic glare in patients with iris loss, atrophy, or trauma. It has also shown efficacy in individuals with conditions such as aniridia or iris coloboma, reducing light scattering and photophobia,” she said.
According to Dr. Karunakaran, this procedure can also be used on seeing eyes to deal with functional issues and is often a safe surgery that is straightforward to learn and do.
It does not require costly supplies and avoids the need for more complex and intrusive eye reconstructive surgeries, she said. However, complications could arise.
So, what is the process of Keratopigmentation?
According to Prime Hospital’s Dr. Lamba, the process of Keratopigmentation can be done using two methods – injections or laser techniques – which use certain dyes.
“There are different kinds of dyes used for the purpose. Some of these dyes can be toxic for the eye and can lead to blind eye. Currently, bio-pigments are used where are safer and fewer short-term complications are reported,” he said.
Adding to this, Dr. Karunakaran said KTP can be done with manual methods or using femtosecond lasers.
Femtosecond lasers are a type of laser that emit ultrashort pulses of light just one quadrillionth of a second in duration, offering unique properties.
Due to their extremely fast pulses, femtosecond lasers can deliver high peak power while minimising heat damage to surrounding areas. This makes them well-suited for delicate medical procedures like LASIK eye surgery, where they precisely reshape the cornea.
In Keratopigmentation, femtosecond lasers allow for the creation of an optimal corneal tunnel with precision and low risk of damaging ocular tissues, representing an innovative approach for the eye tattooing procedure.
With manual methods, a corneal layer is lifted at around 40 percent into the corneal thickness, where the pigment is placed. However, she said using femtosecond laser for KTP is a more innovative approach.
“Before employing the femtosecond laser, it is essential to measure the corneal thickness to ascertain the optimal lamellar depth for creating the tunnel. Once the tunnel is established, the pigments can be precisely injected into the designated area.”
Dangers of Keratopigmentation according to UAE experts
While the procedure is generally considered safe, according to Dr. Karunakaran, complications are usually classified based on when they occur as either during the procedure or after.
“Intraoperative complications commonly encompass perforation, corneal melting, infections, epithelial erosions, and inadvertent dye leakage into the conjunctival space or anterior chamber. Conversely, late-onset complications may manifest as light sensitivity, inconsistent pigmentation of the corneal opacity, pigment fading, uveitis, corneal edema, conjunctivitis, epithelial defects, and potential limitations in the visual field,” she said, adding that achieving desired results may require “additional augmentation.”
Which is why, Prime Hospital’s Dr. Lamba advises individuals to consult a physician to know the exact substance used before undergoing the procedure.
“Different substances can have varied level of safely. Most common issue is fading of the pigments in 4 to 5 years for which they will need a repeat procedure. It is difficult for a surgeon to perform other procedures on the eye if needed e.g. cataract surgeries, retinal surgeries. Although rare, but there are reports of pigments finding a way inside the eye leading to reactions and inflammations,” he said, warning that KTP can trigger:
- Dry eye, irritation and watering
- Abnormal corneal thinning
- Light sensitivity
- Allergies
- Cataract
- Glaucoma
- Interior eye inflammation
- Corneal opacities
- Blindness
“Benefits are cosmetic – to hide corneal opacities and to get the colour of the eye changed. In patients with corneal opacities, pigmentation or dying can reduce the glare,” he said, adding that this this procedure is most common in the West, rather than the Middle East.
“There is lack of long-term substantial evidence proving the procedure to be safe, hence most of the ophthalmic societies are hesitant to recommend it,” he said, adding that contact lenses are a safer choice.
“Fading is common in 4 to 5 years, that will need a re do. However, the effect is irreversible,’ he added.
Dr. Karunakaran further explained that in a study involving 100 patients who underwent keratopigmentation, 60 percent were females, of which 70 percent had previously used alternative pigmentation methods. Among them, 25 percent pursued the procedure for cosmetic purposes.
“Patients commonly reported experiencing symptoms such as pain, dryness, tingling, redness, and glare during the peri- and post-operative periods,” she said, adding that the procedure can “significantly boost” patient confidence, particularly among those intolerant to contact lenses.
