Ophthalmologists Warn Against Surgery to Change Eye Color

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While some consumers are turning to products marketed as eye color-changing drops in search of their preferred hue, others are pursuing an even more invasive option, reportedly paying thousands of dollars for surgery to change their eye color.

Amid concerns from ophthalmologists, patients have said the procedure, known as keratopigmentation or eye tattooing, is worth the potential risks.

The process involves “tattooing the cornea, the front windshield of the eye, “Allison Coombs, DO, MS, director of oculofacial plastic surgery at Northwell Health’s Manhattan Eye, Ear & Throat Hospital and Lenox Hill Hospital in New York City, told MedPage Today.

Though this kind of procedure has been used for many years for patients with certain conditions — such as being born without the colored part of their eye and having light sensitivity as a result — in the past few years, patients have been “dabbling more in aesthetics,” Coombs said.

Ophthalmologists have been more comfortable accepting the risks involved for patients with medical indications, she noted, but this is not the case for those who want the procedure for aesthetic reasons.

One thing to consider is that most of the cornea may be covered in a procedure for aesthetic reasons, rather than just a section of the eye that may be targeted in a procedure for medical reasons, Coombs explained.

Risks associated with the procedure include vision-threatening infections and inflammatory issues, as well as pigment migration and quality issues like changing, fading, or altering of color over time.

Ultimately, there are “not enough data as an ophthalmic community for us to say whether this is safe or not,” Coombs said.

Indeed, the American Academy of Ophthalmology (AAO) issued a statement earlier this year that warned of the dangers associated with eye color-changing procedures as they trended on social media.

“The natural cornea is crystal clear and shows the color of the iris underneath it inside the eye,” the AAO explained. In keratopigmentation, the process “involves using a needle or a laser to create space in the cornea itself, into which a color pigment is injected, permanently changing the cornea from clear to opaque and covering over the natural iris color inside.”

The organization also highlighted a variety of risks with the procedure, including:

• Damage to the cornea that can lead to cloudiness, warpage, fluid leakage, and vision loss
• Light sensitivity
• Reaction to the dye, which can cause inflammation, uveitis, or blood vessel growth into the cornea
• Bacterial or fungal infection, which can produce corneal scarring and vision loss
• Uneven distribution of the dye
• Leakage of the dye into the eye
• Color fading due to the dye moving or leaking into the eye

“Don’t think that these surgeries carry no risk,” JoAnn Giaconi, MD, a clinical spokesperson for the AAO, said at the time. “No surgery is free of risk. With purely cosmetic surgeries on the eye, it’s just not worth the risk when it comes to your good vision.”

The AAO also pointed to potential risks associated with iris implant surgery, which is FDA approved, but for individuals who are missing part or all of the colored part of their eye due to an injury or birth defect. “Patients who have the procedure for medical reasons also risk complications from implant surgery, but the benefits of gaining an iris may outweigh their risks,” the organization said.

Aside from surgeries, the AAO has warned against products being marketed as eye color-changing drops, noting that manufacturers claim the eye drops include an ingredient that adjusts natural levels of melanin in the iris.

However, there is “nothing approved by the FDA that can actually do this,” Alina Djougarian, MD, an ophthalmologist at Northwell Health, previously told MedPage Today. Statements like a “brown eye turning blue” are “false advertising,” she said.

She explained that the pigment of the eye is genetically determined, and depigmentation could lead to serious inflammation or elevated pressure in the eye, which could then lead to glaucoma or other serious conditions that could cause blindness.

Coombs said that information about eye color-changing procedures circulating online and on social media is “extremely concerning.”

“For people who are looking for that cosmetic gain, the only people we are hearing from are having a positive experience, but we just don’t have enough data [to say] ‘take your healthy eyes and go change the color,'” she added.

The AAO has stated that the safest way to change eye color is the use of colored contact lenses, which should only be worn as prescribed, dispensed, and fitted by a qualified eye health professional.

Coombs concurred. Keratopigmentation for aesthetic purposes is both “risky and permanent,” she said. “It’s impossible to un-tattoo your corneas.”