John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

Interests: Eye-Medical Blog
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Eye Whitening Surgery; Iris Color Change Surgery; "bling" On Eye NOT RECOMMENDED

Oct 31, 2013 - 11 comments

Surgical Whitening procedures


Eyeball "bling"


Cosmetic iris color change

There are some very dangerous to moderately complication prone cosmetic procedures that are advertised on the internet. Articles are have been published in major Ophthalmology journals world-wide reporting complications anywhere from failing to make the eye whiter, to surgery necessary to remove "bling" to loss of the eye.

This is not cosmetic eye surgery to give the eyelids a more youthful appearance (blepharoplasty) or a rounder shape. Let us look at these other cosmetic eye operations that are causing problems starting with the most serious:

COSMETIC EYE COLOR (IRIS) CHANGE: First let's say what this isn't. We are not talking about surgery to rebuild a traumatized iris or an eye born without an iris (aniridia). This is legitimate surgery to correct often completely disabling light sensitivity and glare. It is done by skilled surgeons using prosthetic iris implants that have been clinically tested and approved by appropriate national agencies.   Nor is this using a laser to alter iris color although I would never recommend this surgery to a patient of mine. Nor are we talking about contact lens to alter the appearance of the eye iris color when worn if the contacts are fit by a skilled ophthalmologist or optometrist and worn by an informed and meticulous patient.  

So what are we talking about? NEVER is it worth considering having the eye have major surgery inside the eye in which an incision is placed in the cornea and a colored disk placed within the eye. This type of surgery has caused infection, bleeding, cornea clouding, chronic inflammation, severe pain, permanent loss of vision and blinded eyes. Many of these have been done in Panama. Other cosmetic iris intraocular implants allegedly are being done in Mexico and Turkey.  

COSMETIC PERMANENTLY PLACING OF TRINKETS ("BLING") ON THE SURFACE OF THE EYE.  These are not like body piercing, dental grill work or tattoos.  Often shaped like shamrocks, hearts, musical notes, etc. They have to be implanted surgically under the outer layer of the eye (conjunctiva) and over the white eye wall (sclera). Problems have included infection, inflammation, scar formation, chronically red and watery eyes. Removal surgery is often necessary and they eye may remain red and irritated looking and permanently watery and inflamed.

COSMETIC EYE WHITENING: This does not refer to removal of sun damaged tissue that is growing over the cornea called pterygia (singular pterygium). It does refer to surgery to remove pinguecula, thick tenon fascia or fat from the eye surface just to improve cosmetic appearance. Technically this is called "regional conjunctivectomy with or without post operative injection of mitomycin and/or bevacizumab".  A recent report (2013) in the American Journal of Ophthalmology of 557 people having this surgery found 70% post operative complications of which 34% were severe. 40% of the people having this surgery were dissatisfied or very dissatisfied. Dry eyes were common.
This type of surgery is reported to cost $3,500 to $5,500 USD and is not covered by insurance.

SUMMARY: At this writing (10/31/13) cosmetic iris implants surgically placed within the eye are NOT RECOMMENDED by almost all ophthalmologist, Eye MDs. Most all ophthalmologists would NOT RECOMMEND cosmetic eye whitening or cosmetic trinkets ("bling") placed surgically under the surface of the eye (conjunctiva). Assuming these risks to vision, eye comfort and appearance and incurring brutal out of pocket expenses in the hopes of making one slightly or questionably more attractive is not a rational or logical course of action.

John C. Hagan III, MD, FACS, FAAO

photo: an uninflamed and thus far complication free  heart shaped "eye jewelry" (bad idea): source michaelKooren/Reuters/RichmondEye

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Avatar universal
by Perak, Jan 01, 2014
Doctor, I am 54 year old female. I need your advice in occludable angles glaucoma. I have been told by my doctor that I have Occludable angles Glaucoma in both my eyes. I am so nervous.  I do not want to loose my vision.  Please advice. Thank you in advance for your advice.

To Perak:  This better belongs in the Eye Care Community, Go there. I have answered it. JCH MD

Avatar universal
by Perak, Jan 03, 2014
Thank you dear Doctor Hagan.  I truly appreciate your kindness.

Avatar universal
by JustMeKC2014, Jan 04, 2014
The "bling" thing sounds absolutely ridiculous!  What you didn't address here (you may have somewhere else), is the tattooing of the sclera.  I think it looks disgusting, not to mention dangerous!

I had a pterygium removed from my right eye, as it was traveling into the iris and affected my vision.  That in itself was painful, (but necessary) WITH the numbing agents, so I could not fathom doing something such as eye bling or tattooing on purpose without proper professional medical assistance.

Thank you for the article.  This world has come up with some ridiculous ideas!

           True tattoos are done on the eyelid but not the sclera or eyeball. The most common type of eyelid tattoo is "permanent eyelid  make-up".  This is often done for people with a disease where there is no body hair (alopecia totalis) and black permanent ink is applied with a tattoo needle to an do eye liner effect and create artificial dyed eyebrows.  Some people have this done when they are unable to apply their own make-up due to stroke, tremor, etc. Some do it for convenience and to save time or they work/play in water.  I have taken care of many of these people and they generally do well. Over many years the dye can "run' like tattoos elsewhere.
            The sclera is not tattooed in the sense of using a traditional tattoo needle to create an design. The structure of the eye with the conjunctiva and Tenon's fascia over the sclera prevent the use of a tattoo needle to make precise designs/drawings as on the skin. Instead a syringe and needle are used to inject a permanent ink into the subconjunctival space discoloring the surface of the eye.  
            Advising against this is like saying "don't stick your finger into the fire". No reasonably intelligent person would ever consider it and those that would consider or actually do are so intent on making themselves look bizarre that such warnings are always unheeded.


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by Hollus, Jan 05, 2014
John C Hagan III, MD, FACS, FAAO,

Your previous post is not accurate! There is a gentleman who had his sclera tatooed. Here is the news report and pictures to view.


Personally, I would never have this done as the risks far outway the benefits but people do strange things and much is possible!!

No, I'm correct. The article is incorrect in describing the procedures as a tattoo.  Tattoos are made with needles not syringes.  Also the sclera is very structurally tight and interlaced and would not diffuse the dye if the dye was injected into it. Looked at over 30 photos of different people that alleged to have eyeball tattoos and all of them have had dye injected with a syringe subconjunctivally.

This is from that article: " The irreversible procedure involved using a syringe to inject ink"

Never expect accuracy from the press especially the English Tabloids.


Avatar universal
by ando35, Jun 02, 2014
Anyone stupid enough to have jewelry surgically implanted in their eyeball deserves the Darwin Award.

No argument there. JCH MD

Avatar universal
by JulieRox, Jan 06, 2016
What on earth possesses people to undergo such dangerous, stupid procedures?  I daresay those who are intent on making themselves "stand out from the crowd" in such a bizarre way are not the type of people who consider the folly of what they're doing.  They are though, all too often, the type of people who expect others to sort out the ridiculous injuries they inflict on themselves.  As they say where I come from, "Hell slap it intae them!", in other words, it's your own stupid fault, suck it up.

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by JohnHaganMD, Jan 06, 2016
Agree. Not sure which is most difficult to comprehend:  infinity or human stupidity.  

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