Tattoo-associated uveitis: An emerging eye health challenge

Tattoo-associated uveitis was once considered rare; however, that appears to be no longer true, according to a new Australian report that describes this effect as an emerging eye health challenge, according to Ezann Siebert and colleagues. Siebert is from the Royal Perth Hospital, Perth, Western Australia.

“Tattoo-associated uveitis is a potentially sight-threatening condition driven by a presumed immune reaction to tattoo ink. The case numbers may be rising as tattooing becomes more popular,” the investigators commented.

The ink used in tattoos can cause many inflammatory reactions, and while the skin reportedly is the most common site, systemic inflammation also has been reported. The signs of skin inflammation include scattered papules, nodules, scaling, induration, pruritus, and tenderness at the tattoo site.² Granulomatous reactions have been reported in association with allergic dermatitis, foreign body granuloma, melanoma, sarcoidosis, hematological malignancy, and metastatic solid organ cancers.³

In the eye, tattoo-associated uveitis results from an immune response triggered by tattoo pigment, especially that in black ink,^4-6 according to the authors. Currently, about 39 cases have been reported. “Inflamed tattoos are most commonly associated with bilateral anterior uveitis, but posterior involvement, including optic disc swelling, cystoid macular edema, and retinal detachment, also has been reported.¹

In the study under discussion, which they describe as the largest case series thus far, the authors collected demographic information, clinical findings, investigations, treatment, and disease course with the goal of better defining tattoo-associated uveitis and its implications.

In this multicenter retrospective case review, the investigators collaborated with uveitis specialists from January 2023 to January 2025.

What did the analysis of the tattoo-associated uveitis case show?

The investigators analyzed 40 cases (78 eyes; 23 males), the majority of which were young adults aged 21 to 40 years.

“Inflammation within tattoos was present in all cases, most commonly associated with black ink. Systemic treatment was needed in 27/40 (67.5%), of which 25/40 (62.5%) required steroid-sparing immunosuppression, most commonly methotrexate. Biologic disease-modifying antirheumatic drugs were required in 17/40 (42.5%),” they reported.

Topical treatment alone was effective in only 10 (25%) patients, and only just 11 patients (27.5%) achieved a sustained remission when they were off treatment. The complications reported were cataracts, cystoid macular edema, and glaucoma. Only three patients had no visual loss during the treatment course, the investigators found. The documented visual acuities were worse than 6/9 in six patients (15.4% of eyes), the authors reported.

Siebert and colleagues believe that tattoo-associated uveitis “appears to be emerging as a public eye health issue,” considering that the numbers of individuals undergoing tattooing are rising.

They believe that the 40 cases of tattoo-associated uveitis indicate “that this previously rare condition has become a regular entity in Australian uveitis clinics in a population where 25% of people have tattoos. Vision was commonly affected, and 63% required long-term immunosuppression, including with biological disease-modifying antirheumatic drugs in 42%, making this a public eye health issue of concern,” they concluded.

References

1. Siebert E, Moynihan V, Ali N, et al. Tattoo-associated uveitis: an emerging eye health challenge. Clin Exp Ophthalmol. 2026;54:33-43. https://doi.org/10.1111/ceo.70012

2. Abdel-Aty A, Apostolopoulos N, Kombo N. Uveitis associated with tattoo granulomas. BMJ Case Rep. 2022;15:e244196.

3. Bose R, Sibley C, Fahim S. Granulomatous and systemic inflammatory reactions from tattoo ink: case report and concise revies. SAGE Open Med Case Rep. 2020;2050313X20936036.

4. Olisova OY, Teplyuk NP, Grabovskaya OV, et al. Sarcoid granulomas and systemic sarcoidosis triggered by cosmetic tattoos. Curr Probl Dermatol. 2022;56:245-50.

5. Radetic M, Khan S, Venkat A, Mendel T, Phelan M. A tattoo granuloma with uveitis (TAGU) without sarcoidosis. Am J Emerg Med. 2020;38:2489.e3-2489.e5.

6. Sepehri M, Carlsen KH, Serup J. Papulo-nodular reactions in black tattoos as markers of sarcoidosis: study of 92 tattoo reactions from a hospital material. Dermatology. 2016;232:679-86.