Purpose: To report a novel complication of scleral tattooing: inadvertent lacrimal gland infiltration leading to dacryoadenitis and pigmented dacryorrhea. Methods and Results: A case report of a 25-year-old woman who presented to the emergency department with persistent unilateral eye pain, photophobia, and a history of bright blue tears 4 months after undergoing a scleral tattooing procedure. Diagnosis was confirmed via clinical ophthalmological examination and contrast-enhanced orbital computed tomography (CT). Examination revealed teal tattoo pigment within the palpebral lobe of the ipsilateral lacrimal gland, which was enlarged and tender, consistent with dacryoadenitis. Pigment was also noted in the limbal vasculature. Orbital CT confirmed anterior globe pigment deposition without evidence of globe penetration, cellulitis, or abscess. The patient's symptoms resolved with a conservative management strategy of topical antibiotic-steroid drops and lubrication. Conclusions: This case expands the known spectrum of scleral tattoo-related complications to include lacrimal gland involvement and pigmented tearing. It demonstrates that severe adnexal morbidity can occur even in the absence of globe penetration. Ophthalmologists should be aware of this potential complication and carefully examine the lacrimal system in patients with a history of ocular body modification. This report underscores the substantial risks of scleral tattooing and reinforces the need for patient counseling against the procedure.
Escobar et al. (Mon,) studied this question.