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Adverse Reactions to Permanent Eyeliner Tattoo

Purpose: To report the potential for serious adverse reactions associated with permanent eyeliner tattoos. Methods: An observational case series was conducted on 4 patients who presented with inflammatory eyelid reactions after receiving permanent eyeliner tattoo. Results: Clinically, the tattoo-associated lesions were typically firm, raised masses underlying the areas of pigmentation. Histopathologic analysis of tissue from all 4 patients demonstrated a granulomatous inflammatory response with negative cultures for any organisms. Treatment approaches varied between a combination of topical steroid creams, local steroid injections, local resection, intramuscular steroid injection, and systemic oral steroids. These treatments were successful in all 4 cases. Conclusions: An allergic granulomatous reaction is one of the adverse reactions seen after permanent eyeliner tattoo. Treatment can be challenging and may ultimately require excision of tattoo pigment to remove the inciting factor. Systemic steroids may aid in controlling the inflammation associated with reaction to the tattoo pigment.