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    Cosmetic eyeliner tattoo as risk factor for ocular surface disease

    Patient had allergic granulomatous reaction to blepharopigmentation




    At the time of her referral, ocular examination showed a distance visual acuity of 20/20 and 20/25 in the right and left eye, respectively. Pupils, IOP, motility, and confrontation visual fields were normal. External examination was notable for upper and lower lid edema along with rosacea skin changes.

    Slit lamp examination of the anterior segment demonstrated bilateral crusting and ulceration along the lashes as well as eyeliner (Figure 1), papillofollicular reaction of the conjunctiva, superficial punctate keratitis, and LASIK flaps with mild peripheral epithelial ingrowth in the cornea. The anterior chamber was deep and quiet, iris was round and reactive, and the lenses had trace nuclear sclerosis. Dilated fundus examination was unremarkable.

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