Nellie Pretorius first noticed blurriness in one eye, then the other. Doctors thought it was conjunctivitis. Tests said otherwise.
“I was almost blind,” she recalls. “I was losing my vision, but no one could tell me why,” she said. ABC.
The source of the problem was not in her eyes at all. It was a tattoo on her back years ago.
Australian researchers have now recorded 40 cases of a condition called tattoo-associated uveitis, an inflammatory disease that can threaten vision. This complication was once thought to be very rare, but it may occur more often than doctors realize.
Uveitis occurs when the immune system inflames the uvea, the middle layer of the eye. Symptoms include blurred vision, pain, redness, and sensitivity to light. Without treatment, inflammation can progress to glaucoma or permanent vision loss.
Tattoo-related uveitis seems to start far away in the eye. Scientists suspect that the immune response to tattoo pigments may mistakenly target eye tissue, but the mechanism is still unclear.
Ophthalmologist Josephine Richards clearly explained the mystery as follows: “We don’t know why the eyes get caught in the crossfire.” “There’s something about the immune response that targets the eyes.”
A rare situation has emerged
Mr Pretorius’ case is no longer an isolated one. Across Australia, specialists began noticing similar patients, many of them young and tattooed, presenting with unexplained eye inflammation.
“I realized it four or five years ago, and as soon as I realized it, all of a sudden I had more patients,” Richards said.
As ophthalmologists compared notes at expert meetings, the pattern became difficult to ignore. The new study identifies dozens of cases across the country, potentially double the number described in the scientific literature since 2010.
Most patients required long-term treatment to suppress the immune system. Only three patients maintained normal visual acuity throughout treatment, while other patients experienced varying degrees of visual impairment. Some were unable to reduce their medication, a problem for clinicians who are used to seeing autoimmune eye diseases go away over time.
“What we’re really concerned about is that we’re not getting these people off drugs,” Richards said. “Typically, with immune diseases, we treat for two years and then gradually taper off the treatment and hope that the patient is okay with stopping the treatment. But in most cases, we can’t taper off the treatment.”
The ink itself is the main suspect. Black pigment most often appeared in affected patients, but in some cases red or pink ink appeared on the surface. Symptoms usually appeared one to two years after getting the tattoo, but in one surprising case, they appeared more than 30 years later. Additionally, many tattoos are done overseas, making it difficult to accurately trace the chemical composition of the dye.
Despite the alarming stories, experts stress that the overall risk remains small. Research shows that around 20-30% of Australians have tattoos, meaning millions do not experience such complications. Still, the concentration of infections raises new questions about who is vulnerable and why.
clues to immunity
Some answers may lie in an illness similar to tattoo-related uveitis. Inflamed tattoos can look very similar to sarcoidosis, an inflammatory disease in which immune cells form clusters in organs such as the lungs and skin.
“When you do a biopsy of an inflamed tattoo, it looks almost identical to what you see on the chest with sarcoidosis,” Richards explained.
Genetic susceptibility can shape how an individual’s immune system reacts to tattoo pigments. The microbiome may also influence response, but the evidence is still preliminary.
For patients, the impact is immediate and personal. Pretorius has spent thousands of dollars on treatment and continues to rely on steroid eye drops.
“I think there’s a risk when you get a tattoo that you might regret it later,” she says. “[The real risk is] You may lose your eyesight. ”
However, neither patients nor doctors expect tattoos to disappear. “So many people get tattoos and I think it’s very hard to stop people from getting tattoos,” Richards said.
Instead, researchers hope to make tattoos safer by identifying problematic pigments and raising clinician awareness. Early diagnosis can prevent irreversible damage, especially when unexplained uveitis appears in people with tattoos.
Pretorius considers himself lucky. “There are some people. [with tattoo-associated uveitis] “I lost my vision permanently, so it was a relatively good outcome,” she said.
As tattooing becomes increasingly common, this study identified a rare pathway by which immune responses to skin pigments can threaten vision. Early detection and detailed study of the mechanisms involved remain essential to prevent avoidable harm.
The survey results were published in a magazine Clinical and experimental ophthalmology.
