- The FDA has not approved cosmetic surgery to change eye color due to risks and lack of long-term data.
- The American Academy of Ophthalmology suggests colored contact lenses instead of risky cosmetic eye surgeries.
- Proponents say the complication rate is low and usually short-lived.
Folks who want to change their eye color can try iris tattooing or iris implants, but neither is approved by the U.S. Food and Drug Administration and both come with risks of complications that could be serious, according to the nation’s largest ophthalmology group.
The surgeries are growing in popularity, to the chagrin of the American Academy of Ophthalmology, which warned early last year that they could be dangerous. The group has not changed its collective opinion.
Eye tattooing is actually called keratopigmentation and involves injecting a dye of the desired eye color into the normally clear cornea to cover the natural iris.
Iris implants involve cutting a small slit in the cornea and unfurling a silicon implant to cover the natural iris.
Risks of iris tattooing
The risks of keratopigmentation, per the academy, include:
- Harm to the cornea that can cause cloudiness, leakage and vision loss, among others.
- Light sensitivity.
- Allergic reaction to the dye itself, which can create a group of problems including swelling, uveitis or blood vessel growth in the cornea. Uveitis is swelling in the eyeball’s middle layer.
- Bacterial or fungal infection.
- Dye run amok, with uneven distribution or even leakage into the eye.
- Color fading.
“Don’t think that these surgeries carry no risk,” said Dr. JoAnn A. Giaconi, clinical spokesperson for the academy. “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 academy says those who want to change their eye color should use colored contact lenses, but be sure not to wear them too long at a time, keep them clean and handle them properly. And only use contacts that are prescribed by a vision professional.
Risks of iris implants
The academy also lists possible risks of the iris implants, including:
- Damage to vision, including even blindness.
- Sensitivity to light.
- Raised eye pressure that could cause glaucoma, a serious eye disease that can also lead to blindness.
- Cataract that clouds the eye’s lens.
- Corneal injury. The cornea focuses light and lets people see. If it’s badly damaged, a corneal transplant might be needed.
- Inflammation of the eye, which can cause pain, blurriness and tearing.
Differing views
The Deseret News first wrote about the procedures and potential risks in late November, noting that those performing the procedures say they are safe, with little in the way of long-term complications.
As Dr. Roberto Pineda, an ophthalmologist at Massachusetts Eye and Ear, said at the time, he has performed medical keratopigmentation for three decades for medical reasons. He told The Wall Street Journal that the procedure not only helps the eye’s appearance after illness or injury, but it “can also help reduce debilitating glare caused by iris or corneal damage.”
The medical keratopigmentation that restores a more natural look after injury or due to the iris not forming properly has been around for a couple of decades, so Scientific American noted it may offer longer research on potential risks. The cosmetic use, however, falls far short of the 30 years’ follow-up that Dr. Diane Hilal-Campo told Scientific American would be ideal to assess whether it’s worth taking a chance on harm.
Pineda said he tells students that the cosmetic form of the procedure “lacks scientific rigor,” and warns them that “you want to be on the cutting edge, not the bleeding edge.”
But doctors who have performed the surgery for cosmetic reasons have encouraged the academy to take back the group’s criticisms, noting studies see relatively few complications and that most resolve in a short period of time.
Per the Scientific American article, “The largest study of outcomes to date, published in 2018, surveyed 204 people who’d undergone keratopigmentation in the past four months to 12-plus years. Of the 29 people who developed complications, 49% suffered light sensitivity that tended to resolve after six months; 19% saw their new eye color fade or change; and 4% and 2%, respectively, experienced slight visual field limitations or pain in magnetic resonance imaging (MRI) machines. A 2021 study conducted by some of the same co-authors, who surveyed 40 cosmetic keratopigmentation clients two-and-a-half years after their operation, reported similar but less frequent complications. The authors of that study wrote in their paper that this shift reflected advancements in technique. More recent research documented five cosmetic keratopigmentation recipients who later developed ectasia, a corneal bulge that can distort vision without treatment."
That article, too, notes most ophthalmologists continue to recommend colored contacts, rather than permanent eye color change.