The risk of a bad tattoo: it’s worse than you think

by Jeff Megahan, Features Editor, Optometry Australia

Most of us know someone bearing the permanent indignity of a really bad tattoo. From the awkward to the absurd, bad tattoos are an everlasting reminder of our ability to make poor choices from time to time.

But a growing number of unlicensed or ‘backyard’ tattoo artists in states and territories in Australia may be putting people at risk of something more serious: tattoo-associated uveitis—a condition that can damage vital eye tissue and lead to permanent vision loss.

Uveitis (you-vee-i-tus) is an inflammation of the eye that is a consequence of the body’s natural response to tissue damage, germs or toxins. As white blood cells rush to eliminate an infection in a certain part of the body, it shows up as redness.

The uvea is the middle layer of the eye which contains much of the eye’s blood vessels; it’s located between the white outer coat of the eyes and the inner layer, called the retina. The uvea contains much of the eye’s blood vessels, and this is how inflammatory cells can enter the eye.

Tattoo-associated uveitis is rare – up until 2014, the number of cases was in the single digits. However, with the main-streaming of body art and the proliferation of amateur tattoo artists, optometrists have seen an increase in the number of patients presenting with the tell-tale signs of the condition.

Image: Shutterstock

Case report

In the December 2019 issue of Optometry Australia’s professional member magazine Pharma, Debra Gleeson from the Royal Victorian Eye and Ear Hospital reports on a patient who presented with blurry vision, ocular redness and a ‘feeling of pressure’ in both eyes.

After several visits, the patient explained that his eye problems started around the time he got his tattoo – which was inflamed, red and ‘lumpy.’ The diagnosis: tattoo-associated uveitis.

As Debra Gleeson explains, "tattoo-associated uveitis can occur from at least six months after the getting the tattoo to up to 13 years. Most of the reported cases involved black inks that contained toxic, mutagenic or carcinogenic compounds.

"The chemicals used in tattoos are classified as industrial chemicals in Australia, and state and territory authorities are responsible for regulating the safety of tattoo inks. But these important regulations might not be adhered to, especially if the tattoo artist is unregistered or is in a country without a regulatory body."

What to do if you suspect tattoo-associated uveitis

A patient with tattoo-associated uveitis may present at their optometrist with an inflammation of the tattooed skin and an inflammation of the eye. Often, the parts of the skin around the tattoo are raised and hard. Their eyes may be red and their vision may be blurry; they may report eye pain, increased ‘floaters’ and photophobia – that is, oversensitivity to light exposure.

It’s important to point out that tattoos do not cause uveitis. However, if you or someone you know is experiencing a skin inflammation associated with a new tattoo, with eyes that are red and inflamed as well, a visit to the optometrist is strongly recommended. Immediate treatment may reduce the severity of the problem and help to avoid serious side effects.

How to avoid it

It’s impossible to know who will get tattoo-associated uveitis. But we do know that risk increases with the number of tattoos a person has and the size of the tattooed area, particularly with black ink. Also, the risk increases when a number of tattoos are obtained over a short period of time.

For those still considering a tattoo, Debra Gleeson has these words of advice: "It’s best to make sure that the tattoo parlour follows government regulations in regard to what inks can be used."  Avoid ‘backyarders’ who may use unsterilised needles and tattoo ink containing numerous, unregulated ingredients.

The regulated tattoo parlours that comply with their state’s Public Health Acts provide clean conditions and non-toxic inks may be more expensive, but its best to roll your protection from infection into the cost, as well as the amount of time and anguish you are saving in the treatment of a serious eye condition.

Ultimately, for your self-esteem—and your vision, it’s best to follow the old tattoo-artists’ mantra: "good tattoos ain’t cheap and cheap tattoos ain’t good."

 

You can read more about tattoo-associated uveitis here.

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