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    Cosmetic eyeliner tattoo as risk factor for ocular surface disease

    Patient had allergic granulomatous reaction to blepharopigmentation



    Ophthalmologists should consider cosmetic permanent eyeliner tattoos (blepharopigmentation) as a risk-factor for ocular surface disease.

    Allergic granulomatous reaction to blepharopigmentation should be on the differential diagnosis for patients presenting with ulcerative blepharitis and associated ocular surface disease resistant to medical therapy.

    A careful history is critical because patients often can think of it as a cosmetic treatment and not attribute it to be an invasive medical procedure. The degree of pigmentation can fade in time but a delayed allergic reaction can still develop years later. 



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    2.  Vagefi MR, Dragan L, Hughes SM, et al. Adverse reactions to permanent eyeliner tattoo. Ophthal Plast Reconstr Surg. 2006;22:48–51.

    3.  Schwarze HP, Giordano-Labadie F, Loche F, et al. Delayed-hypersensitivity granulomatous reaction induced by blepharopigmentation with aluminum-silicate. J Am Acad Dermatol. 2000;42:888–891.

    4.  Goldberg RA, Shorr N. Complications of blepharo-pigmentation. Ophthalmic Surg. 1989;20:420–423.

    5.  Lee YB, Kim JJ, Hyon JY, et al. Eyelid tattooing induces meibomian gland loss and tear film instability. Cornea. 2015;34:750–755.

    6.  Kojima T, Dogru M, Matsumoto Y, et al. Tear film and ocular surface abnormalities after eyelid tattooing. Ophthal Plast Reconstr Surg. 2005;21:69–71.

    7.  Lu C-W, Liu X-F, Zhou D-D, et al. Bilateral diffuse lamellar keratitis triggered by permanent eyeliner tattoo treatment: A case report. Exp Ther Med. 2017;14:283–285.

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