Tattoo-Associated Uveitis


      To describe the clinical presentation of uveitis with coincident onset of raised and indurated tattooed skin.


      Case series.


      Seven consecutive patients were evaluated at a tertiary ophthalmologic facility with coincident uveitis and cutaneous tattoo induration over an 18-month period. All subjects underwent complete ophthalmic examination and a focused systemic medical evaluation including serologic testing and imaging studies. Two participants underwent biopsy of their tattoos. The patients' clinical courses and responses to treatment over a follow-up period of 1–20 months are reported (mean follow-up = 9 months). Main outcome measures included degree of intraocular inflammation, ocular complications, visual acuity, clinically observable tattooed skin changes, and biopsy results.


      Five of 7 patients had bilateral nongranulomatous anterior uveitis: 4 with chronic and 1 with recurrent disease. The remaining 2 patients had bilateral chronic granulomatous panuveitis. Biopsies of raised and indurated tattoos were performed in 2 patients and demonstrated noncaseating granulomatous inflammation surrounding tattoo ink in the dermis. The skin changes resolved in all patients, with a faster response noted in those treated with high-dose oral prednisone for intraocular inflammation. Five patients subsequently experienced recurrent flares of intraocular inflammation in conjunction with the recurrence of raised and indurated tattoos.


      These cases represent a subset of patients in whom skin tattooing may have incited an immune response leading to simultaneous inflammation of the eyes and tattooed skin.
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      Trucian Ostheimer, MD, graduated from the Ohio State University College of Medicine in 2008, and completed his ophthalmology residency at the Illinois Eye & Ear Infirmary in 2012. He is currently completing a two-year ocular immunology fellowship at the Wilmer Eye Institute, and has a special interest in birdshot chorioretinopathy. Dr Ostheimer will begin a fellowship in vitreoretinal surgery at the University of Washington in July, 2014.

      Linked Article

      • Tattoo-Associated Uveitis
        American Journal of OphthalmologyVol. 158Issue 6
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          We were very interested to read the recent article by Ostheimer and associates,1 describing a series of 7 patients with tattoo-associated uveitis. The authors imply that this represents a distinct clinical entity with temporally associated skin inflammation and uveitis, triggered by recent tattooing. Notably, the patients in this series had no evidence of systemic sarcoidosis or infective causes of uveitis. As originally detailed by Rorsman and associates,2 the proposed underlying pathophysiology of this condition is a specific delayed type of hypersensitivity reaction to particular tattoo pigments, which contain metallic compounds such as cobalt, nickel, and iron.
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      • Tattoo-Associated Uveitis
        American Journal of OphthalmologyVol. 159Issue 2
        • Preview
          We read with great interest the article by Ostheimer and associates.1 This is the largest series reporting 7 cases gathered over 18 months at the Ocular Immunology Service at the Wilmer Eye Institute, denoting that the discussed entity is not rare. We attribute this large number to both an increased awareness of the medical community to health hazards of tattooing and increasing numbers of subjects undergoing artistic tattooing.
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